Provider Demographics
NPI:1184182115
Name:PATHWAYS TO RECOVERY ASSOCIATES INC.
Entity Type:Organization
Organization Name:PATHWAYS TO RECOVERY ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-839-8906
Mailing Address - Street 1:PO BOX 961814
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6912
Mailing Address - Country:US
Mailing Address - Phone:404-839-8906
Mailing Address - Fax:404-344-3181
Practice Address - Street 1:7210 CHURCH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2918
Practice Address - Country:US
Practice Address - Phone:404-839-8906
Practice Address - Fax:404-344-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health