Provider Demographics
NPI:1487181087
Name:PATHWAY2RECOVERYKY LLC
Entity Type:Organization
Organization Name:PATHWAY2RECOVERYKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:502-552-2604
Mailing Address - Street 1:214 BRECKENRIDGE LN STE 207
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 BRECKENRIDGE LN STE 207
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3879
Practice Address - Country:US
Practice Address - Phone:502-552-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care