Healthcare Provider Details

I. General information

NPI: 1184903429
Provider Name (Legal Business Name): PATHWAYS TO SUCCESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E NINE MILE RD
HIGHLAND SPRINGS VA
23075-1857
US

IV. Provider business mailing address

407 E NINE MILE RD
HIGHLAND SPRINGS VA
23075-1857
US

V. Phone/Fax

Practice location:
  • Phone: 804-737-1122
  • Fax: 804-737-1120
Mailing address:
  • Phone: 804-737-1122
  • Fax: 804-737-1120

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1434-05-001
License Number StateVA

VIII. Authorized Official

Name: MR. JAMAAL ALLAH
Title or Position: OWNER
Credential:
Phone: 804-737-1122