Provider Demographics
NPI:1639577950
Name:PATHWAY 2 RECOVERY GOLD COAST, LLC
Entity Type:Organization
Organization Name:PATHWAY 2 RECOVERY GOLD COAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-634-3911
Mailing Address - Street 1:23116A SANDAL FOOT PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6500
Mailing Address - Country:US
Mailing Address - Phone:954-634-3911
Mailing Address - Fax:954-634-3912
Practice Address - Street 1:23116A SANDAL FOOT PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6500
Practice Address - Country:US
Practice Address - Phone:954-634-3911
Practice Address - Fax:954-634-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder