Provider Demographics
NPI:1578193090
Name:LIGHTED PATHWAY DANVILLE, LLC
Entity Type:Organization
Organization Name:LIGHTED PATHWAY DANVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-334-0310
Mailing Address - Street 1:625 PINEY FOREST RD STE 307B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2869
Mailing Address - Country:US
Mailing Address - Phone:434-334-0310
Mailing Address - Fax:
Practice Address - Street 1:625 PINEY FOREST RD STE 307B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2869
Practice Address - Country:US
Practice Address - Phone:434-334-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities