1518242130 NPI number — PATHWAYS COMMUNITY SUPPORT SERVICES, INC

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 1518242130 NPI number — PATHWAYS COMMUNITY SUPPORT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS COMMUNITY SUPPORT SERVICES, 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:
1518242130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 PINE TREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-5224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-462-4000
Provider Business Mailing Address Fax Number:
845-462-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 VIOLET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12538-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-229-4727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RECKESS
Authorized Official First Name:
AZZY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-462-4000

Provider Taxonomy Codes

  • Taxonomy code: 344600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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