1659384824 NPI number — PATHWAY TO RECOVERY, INC.

Table of content: (NPI 1659384824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659384824 NPI number — PATHWAY TO RECOVERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAY TO RECOVERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659384824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2119 OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMARQUE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77568-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-933-4366
Provider Business Mailing Address Fax Number:
409-933-4367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2119 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MARQUE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77568-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-933-4366
Provider Business Practice Location Address Fax Number:
409-933-4367
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOLGIN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
409-933-4366

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1904-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 1904A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 1904B , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 1904-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 556366 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 265402 . This is a "COMP PSYCH PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH5101 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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