Provider Demographics
NPI:1073001749
Name:PATHWAYS TO LIFE, INC.
Entity type:Organization
Organization Name:PATHWAYS TO LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ONTARIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-695-0269
Mailing Address - Street 1:150 E ARLINGTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5019
Mailing Address - Country:US
Mailing Address - Phone:252-695-0269
Mailing Address - Fax:
Practice Address - Street 1:109 OLDE GREENWICH DR STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4022
Practice Address - Country:US
Practice Address - Phone:540-645-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1229251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health