Healthcare Provider Details

I. General information

NPI: 1326441981
Provider Name (Legal Business Name): SAFEWAY PATHS EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CORPORATE DR 102
HILLSBOROUGH NC
27278-8558
US

IV. Provider business mailing address

1546 WHITE PLAINS CHURCH RD
CLARKTON NC
28433-8954
US

V. Phone/Fax

Practice location:
  • Phone: 910-375-2595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AHMARD BRYANT
Title or Position: SECRETARY
Credential:
Phone: 910-375-2595