Provider Demographics
NPI:1164762563
Name:PATHWAYS YOUTH SERVICES, LLC
Entity Type:Organization
Organization Name:PATHWAYS YOUTH SERVICES, LLC
Other - Org Name:PATHWAYS YOUTH SERVICES III
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:DORETHA
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-476-1040
Mailing Address - Street 1:1099 BAGWELL DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24589-2712
Mailing Address - Country:US
Mailing Address - Phone:434-476-1040
Mailing Address - Fax:434-476-1070
Practice Address - Street 1:1099 BAGWELL DR
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:VA
Practice Address - Zip Code:24589-2712
Practice Address - Country:US
Practice Address - Phone:434-476-1040
Practice Address - Fax:434-476-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRF-279320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness