Healthcare Provider Details

I. General information

NPI: 1235621335
Provider Name (Legal Business Name): PATHWAYS GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N RANSOM ST
GASTONIA NC
28052-1953
US

IV. Provider business mailing address

1349 E GARRISON BLVD STE E
GASTONIA NC
28054-5142
US

V. Phone/Fax

Practice location:
  • Phone: 980-888-0251
  • Fax:
Mailing address:
  • Phone: 980-888-0251
  • Fax: 980-888-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR BANNER
Title or Position: DIRECTOR
Credential:
Phone: 980-888-0251