Provider Demographics
NPI:1114331147
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:LAMONT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-695-0269
Mailing Address - Street 1:1420A S POLLOCK ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-3404
Mailing Address - Country:US
Mailing Address - Phone:919-351-0428
Mailing Address - Fax:919-351-0814
Practice Address - Street 1:1420A S POLLOCK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-3404
Practice Address - Country:US
Practice Address - Phone:919-351-0428
Practice Address - Fax:919-351-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health