Provider Demographics
NPI:1841744869
Name:PATHWAYS TO SERENITY, LLC
Entity Type:Organization
Organization Name:PATHWAYS TO SERENITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICCOBONO
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:609-242-9500
Mailing Address - Street 1:500 MAIN ST STE 2
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2228
Mailing Address - Country:US
Mailing Address - Phone:609-242-9500
Mailing Address - Fax:609-242-9502
Practice Address - Street 1:500 MAIN ST STE 2
Practice Address - Street 2:SUITE 1
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2228
Practice Address - Country:US
Practice Address - Phone:609-242-9500
Practice Address - Fax:609-242-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00187200261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder