Healthcare Provider Details

I. General information

NPI: 1578117297
Provider Name (Legal Business Name): PATHWAYS SUBSTANCE ABUSE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 SHREVEPORT HWY
PINEVILLE LA
71360
US

IV. Provider business mailing address

PO BOX 52466
LAFAYETTE LA
70505-2466
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-1114
  • Fax:
Mailing address:
  • Phone: 337-233-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS HUNTER PERRET
Title or Position: OWNER
Credential:
Phone: 337-233-1114