Provider Demographics
NPI:1235469651
Name:PATH BREAKERS
Entity Type:Organization
Organization Name:PATH BREAKERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SAULS
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:423-329-7508
Mailing Address - Street 1:320 PREACHER LAWS RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:TN
Mailing Address - Zip Code:37616-6450
Mailing Address - Country:US
Mailing Address - Phone:423-329-7508
Mailing Address - Fax:
Practice Address - Street 1:320 PREACHER LAWS RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:TN
Practice Address - Zip Code:37616-6450
Practice Address - Country:US
Practice Address - Phone:423-329-7508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management