Healthcare Provider Details

I. General information

NPI: 1598510349
Provider Name (Legal Business Name): PATHWAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PRIVATE ROAD 1201
NEW BROCKTON AL
36351-7910
US

IV. Provider business mailing address

PO BOX 311206
ENTERPRISE AL
36331-1206
US

V. Phone/Fax

Practice location:
  • Phone: 334-894-5591
  • Fax: 334-894-5264
Mailing address:
  • Phone: 334-464-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ALESHA B BOOTH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 334-464-3668