1699077362 NPI number — PATHWAYS GROWTH & LEARNING CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699077362 NPI number — PATHWAYS GROWTH & LEARNING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS GROWTH & LEARNING CENTER, LLC
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:
1699077362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 673
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29202-0673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-403-8469
Provider Business Mailing Address Fax Number:
803-403-9979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 RICHLAND ST
Provider Second Line Business Practice Location Address:
SUITE B101
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-403-8469
Provider Business Practice Location Address Fax Number:
803-403-9979
Provider Enumeration Date:
12/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BOWMAN
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND FOUNDER
Authorized Official Telephone Number:
803-403-8469

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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