Provider Demographics
NPI:1427193077
Name:PATHWAYS COMMUNITY BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PATHWAYS COMMUNITY BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:MCCAMBRIDGE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDI
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-890-8186
Mailing Address - Street 1:1800 COMMUNITY DR.
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:816-318-3001
Practice Address - Street 1:201 N GARTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4105
Practice Address - Country:US
Practice Address - Phone:573-449-3953
Practice Address - Fax:816-318-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO565213303Medicaid
MO862990702Medicaid