Provider Demographics
NPI:1659869592
Name:PATHWAYS TO GRACE HOMES
Entity Type:Organization
Organization Name:PATHWAYS TO GRACE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAKEISHA
Authorized Official - Middle Name:ANTIONETTE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MBA
Authorized Official - Phone:504-273-9793
Mailing Address - Street 1:PO BOX 58944
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70158-8944
Mailing Address - Country:US
Mailing Address - Phone:504-273-9793
Mailing Address - Fax:504-333-6685
Practice Address - Street 1:2120 NEWTON ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6638
Practice Address - Country:US
Practice Address - Phone:504-273-9793
Practice Address - Fax:504-333-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care