Healthcare Provider Details

I. General information

NPI: 1538973292
Provider Name (Legal Business Name): CREATIVE PATHWAYS TO HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 CHESTER RD STE A
CHESTER VA
23831-1112
US

IV. Provider business mailing address

7806 SILVER MIST AVE
NORTH CHESTERFIELD VA
23237-1976
US

V. Phone/Fax

Practice location:
  • Phone: 804-635-3065
  • Fax:
Mailing address:
  • Phone: 804-586-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELISHA J COLEMAN
Title or Position: CEO
Credential:
Phone: 804-586-6855