Provider Demographics
NPI:1710949292
Name:PATHWAYS OF LICKING COUNTY
Entity Type:Organization
Organization Name:PATHWAYS OF LICKING COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-345-6166
Mailing Address - Street 1:1627 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1505
Mailing Address - Country:US
Mailing Address - Phone:740-345-6166
Mailing Address - Fax:740-349-9894
Practice Address - Street 1:1627 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1505
Practice Address - Country:US
Practice Address - Phone:740-345-6166
Practice Address - Fax:740-349-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1325Medicare UPIN