=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326441981
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFEWAY PATHS EDUCATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2014
-----------------------------------------------------
Last Update Date | 09/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 CORPORATE DR 102
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27278-8558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-375-2595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1546 WHITE PLAINS CHURCH RD
-----------------------------------------------------
City | CLARKTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28433-8954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | AHMARD BRYANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-375-2595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------