Provider Demographics
NPI:1376309302
Name:PATHFINDER RECOVERY
Entity Type:Organization
Organization Name:PATHFINDER RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ELIZABETH LEWIS
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:617-216-6704
Mailing Address - Street 1:2 KLARIDES VILLAGE DR # 197
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2737
Mailing Address - Country:US
Mailing Address - Phone:617-216-6704
Mailing Address - Fax:
Practice Address - Street 1:29 EVERGREEN TER
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3051
Practice Address - Country:US
Practice Address - Phone:617-216-6704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility