Provider Demographics
NPI:1710555933
Name:P.A.T.H.S. PRP
Entity Type:Organization
Organization Name:P.A.T.H.S. PRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-845-2331
Mailing Address - Street 1:100 E PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-0700
Mailing Address - Country:US
Mailing Address - Phone:443-895-4360
Mailing Address - Fax:
Practice Address - Street 1:100 E PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-0700
Practice Address - Country:US
Practice Address - Phone:443-895-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX ALIGHTING THERAPEUTIC HEALING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health