MEDICARE: PATHWAYS TO HOPE 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952654337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAYS TO HOPE LLC

Provider Business Mailing Address
First Line	:	925B PEACHTREE ST NE
Second Line	:	SUITE 960
City	:	ATLANTA
State	:	GA
Zip	:	30309-3918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925B PEACHTREE ST NE
Second Line	:	SUITE 960
City	:	ATLANTA
State	:	GA
Zip	:	30309-3918
Country	:	US
Telephone Number	:	248-943-9842
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	SHANNON WILLIAMS
Credential	:
Telephone Number	:	248-943-9842

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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