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General NPI Number Information
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NPI Number | 1366145625
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Entity Type | Organization
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Legal Business Name | PATHWAY TO RECOVERY LLC
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 59 BROADWAY
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City | TAUNTON
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State | MA
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Zip | 02780-3120
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Country | US
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Telephone | 508-493-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 19 FAIRBANKS AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-1913
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Country | US
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Telephone | 508-493-6064
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Fax |
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Authorized Official
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Title or Position | NP/MANAGING MEMBER
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Name | BETH FITZGERALD
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Credential | NP
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Telephone | 508-386-0916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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