Healthcare Provider Details

I. General information

NPI: 1164520508
Provider Name (Legal Business Name): PATHWAY HOUSE WOMEN'S PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 6TH AVE SW
ROCHESTER MN
55902-6260
US

IV. Provider business mailing address

PO BOX 6610
ROCHESTER MN
55903-6610
US

V. Phone/Fax

Practice location:
  • Phone: 507-287-6121
  • Fax: 507-287-0303
Mailing address:
  • Phone: 507-287-6121
  • Fax: 507-287-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number809746-2-CDT
License Number StateMN

VIII. Authorized Official

Name: MR. GERALD C POWERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 507-287-6121