Provider Demographics
NPI:1396069829
Name:PATHWAYS RECOVERY, LLC
Entity type:Organization
Organization Name:PATHWAYS RECOVERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MCCREA
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:916-398-0729
Mailing Address - Street 1:6538 GREY OAK CT
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1024
Mailing Address - Country:US
Mailing Address - Phone:916-735-8377
Mailing Address - Fax:877-494-5088
Practice Address - Street 1:6538 GREY OAK CT
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-1024
Practice Address - Country:US
Practice Address - Phone:916-735-8377
Practice Address - Fax:877-494-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340098AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility