Provider Demographics
NPI:1578117297
Name:PATHWAYS SUBSTANCE ABUSE, L.L.C.
Entity Type:Organization
Organization Name:PATHWAYS SUBSTANCE ABUSE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:PERRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1114
Mailing Address - Street 1:PO BOX 52466
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2466
Mailing Address - Country:US
Mailing Address - Phone:337-233-1114
Mailing Address - Fax:
Practice Address - Street 1:5505 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:337-233-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2022-03-14
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