Provider Demographics
NPI:1609977503
Name:NEW WAY OUT, CORP.
Entity Type:Organization
Organization Name:NEW WAY OUT, CORP.
Other - Org Name:PETWAY RESIDENTIAL FACILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNEASE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:251-665-4627
Mailing Address - Street 1:PO BOX 191533
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-6533
Mailing Address - Country:US
Mailing Address - Phone:251-665-4627
Mailing Address - Fax:251-661-9599
Practice Address - Street 1:712 OAK CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4222
Practice Address - Country:US
Practice Address - Phone:251-665-4627
Practice Address - Fax:251-666-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL322D0000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33909248Medicaid