Healthcare Provider Details

I. General information

NPI: 1659603512
Provider Name (Legal Business Name): PATHWAYS CBH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COMMUNITY
CLINTON MO
64735-8804
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-8186
  • Fax: 660-835-9449
Mailing address:
  • Phone: 660-890-8186
  • Fax: 660-835-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: TERESA PORTER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 660-890-8126