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General NPI Number Information
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NPI Number | 1538877741
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Entity Type | Organization
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Legal Business Name | PATHWAY RESOURCES CENTER, LLC
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 13000 HARBOR CENTER DR # 364
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2846
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Country | US
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Telephone | 571-462-2000
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Fax | 703-232-1800
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Provider Business Mailing Address
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Address Line | 13000 HARBOR CENTER DR # 364
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2846
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Country | US
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Telephone | 571-462-2000
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Fax | 703-232-1800
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | REMI FORTUNATE ONAWUMI
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Credential |
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Telephone | 571-462-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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