Provider Demographics
NPI:1235616194
Name:PATHWAYS ADDICTION RECOVERY, LLC
Entity Type:Organization
Organization Name:PATHWAYS ADDICTION RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:504-309-8135
Mailing Address - Street 1:3801 HOUMA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4185
Mailing Address - Country:US
Mailing Address - Phone:504-309-8135
Mailing Address - Fax:
Practice Address - Street 1:3801 HOUMA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4185
Practice Address - Country:US
Practice Address - Phone:504-309-8135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty