Provider Demographics
NPI:1386226041
Name:PATHWAY OF BALDWIN COUNTY LLC
Entity Type:Organization
Organization Name:PATHWAY OF BALDWIN COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:334-330-0032
Mailing Address - Street 1:PO BOX 311206
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1206
Mailing Address - Country:US
Mailing Address - Phone:334-330-0032
Mailing Address - Fax:
Practice Address - Street 1:23750 EWING FARM RD
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-4952
Practice Address - Country:US
Practice Address - Phone:334-330-0032
Practice Address - Fax:334-894-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities