Provider Demographics
NPI:1164520508
Name:PATHWAY HOUSE WOMEN'S PROGRAM, INC
Entity Type:Organization
Organization Name:PATHWAY HOUSE WOMEN'S PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-287-6121
Mailing Address - Street 1:PO BOX 6610
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55903-6610
Mailing Address - Country:US
Mailing Address - Phone:507-287-6121
Mailing Address - Fax:507-287-0303
Practice Address - Street 1:103 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-6260
Practice Address - Country:US
Practice Address - Phone:507-287-6121
Practice Address - Fax:507-287-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN809746-2-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility