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General NPI Number Information
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NPI Number | 1184182115
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Entity Type | Organization
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Legal Business Name | PATHWAYS TO RECOVERY ASSOCIATES INC.
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 7210 CHURCH ST
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City | RIVERDALE
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State | GA
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Zip | 30274-2918
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Country | US
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Telephone | 404-839-8906
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Fax | 404-344-3181
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Provider Business Mailing Address
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Address Line | PO BOX 961814
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City | RIVERDALE
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State | GA
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Zip | 30296-6912
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Country | US
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Telephone | 404-839-8906
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Fax | 404-344-3181
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Authorized Official
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Title or Position | CEO
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Name | GLENDA GRANT
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Credential |
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Telephone | 404-839-8906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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