Healthcare Provider Details

I. General information

NPI: 1003059668
Provider Name (Legal Business Name): PATHWAYS TO LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CONFERENCE DR
GREENVILLE NC
27858-5969
US

IV. Provider business mailing address

1202 E FIRE TOWER RD
GREENVILLE NC
27858-4196
US

V. Phone/Fax

Practice location:
  • Phone: 252-695-0269
  • Fax: 252-413-0526
Mailing address:
  • Phone: 252-695-0269
  • Fax: 252-413-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ONTARIO LAMONT CHAPPELL
Title or Position: PRESIDENT
Credential:
Phone: 252-695-0269