Provider Demographics
NPI:1376906651
Name:PATHWAYS RESIDENTIAL AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:PATHWAYS RESIDENTIAL AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-706-5360
Mailing Address - Street 1:2528 COLDSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1238
Mailing Address - Country:US
Mailing Address - Phone:817-882-6237
Mailing Address - Fax:817-882-6238
Practice Address - Street 1:2528 COLDSTREAM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1238
Practice Address - Country:US
Practice Address - Phone:817-882-6237
Practice Address - Fax:817-882-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities