Provider Demographics
NPI:1568500585
Name:PATHWAYS OF MAINE, INC.
Entity Type:Organization
Organization Name:PATHWAYS OF MAINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-373-0620
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-2800
Mailing Address - Fax:540-710-7447
Practice Address - Street 1:16 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2878
Practice Address - Country:US
Practice Address - Phone:207-373-0620
Practice Address - Fax:207-373-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME392123320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME191700400Medicaid