Provider Demographics
NPI:1467825604
Name:PASSAGEWAYS MEDICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PASSAGEWAYS MEDICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/ DIRECTOR OF LEGAL AFFAIR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-424-4452
Mailing Address - Street 1:4006 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4704
Mailing Address - Country:US
Mailing Address - Phone:502-837-7517
Mailing Address - Fax:
Practice Address - Street 1:4006 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4704
Practice Address - Country:US
Practice Address - Phone:502-837-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility