Healthcare Provider Details

I. General information

NPI: 1881338309
Provider Name (Legal Business Name): PATHWAYS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 ROCK SPRINGS RD
PENRYN CA
95663-9622
US

IV. Provider business mailing address

PO BOX 847
FOLSOM CA
95763-0847
US

V. Phone/Fax

Practice location:
  • Phone: 916-735-8377
  • Fax: 877-494-5088
Mailing address:
  • Phone: 916-398-0729
  • Fax: 877-494-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRAHAM
Title or Position: COMPLIANCE MANAGER
Credential: MBA, MS
Phone: 916-398-0729