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General NPI Number Information
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NPI Number | 1356469712
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Entity Type | Organization
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Legal Business Name | PATHWAY TO SUCCESS
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 112 STAGG ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2654
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Country | US
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Telephone | 336-229-2008
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Fax | 336-229-2008
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Provider Business Mailing Address
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Address Line | 2445 HILLFORD DR
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City | BURLINGTON
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State | NC
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Zip | 27217-3173
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Country | US
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Telephone | 336-229-5580
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Fax | 336-229-2008
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. STELLA K FOWLER
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Credential |
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Telephone | 336-229-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | FCL-001-028
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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