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General NPI Number Information
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NPI Number | 1588587430
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Entity Type | Organization
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Legal Business Name | PATHWAY CAMP MITNICK LLC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 4436 CALUMET LOOP
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City | JASPER
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State | AL
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Zip | 35501-7845
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Country | US
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Telephone | 205-600-5265
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 311206
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City | ENTERPRISE
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State | AL
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Zip | 36331-1206
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Country | US
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Telephone | 205-600-5265
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. ALESHA BOOTH
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Credential |
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Telephone | 334-464-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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