MEDICARE: PATHS FOR SUCCESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760624159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHS FOR SUCCESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 244
Second Line	:
City	:	CRAMERTON
State	:	NC
Zip	:	28032-0244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S TRADD ST
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-5859
Country	:	US
Telephone Number	:	704-923-6783
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOANNA PATRONIS
Credential	:
Telephone Number	:	704-923-6783

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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Directions to “PATHS FOR SUCCESS, LLC ” Practice Location

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