Provider Demographics
NPI:1851455638
Name:PATHWAYS CENTER FOR BEHAVIORAL & DEVELOPMENTAL GROWTH
Entity Type:Organization
Organization Name:PATHWAYS CENTER FOR BEHAVIORAL & DEVELOPMENTAL GROWTH
Other - Org Name:CARROLL IGR
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-845-4045
Mailing Address - Street 1:122 GORDON COMMERCIAL DR # D
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-5740
Mailing Address - Country:US
Mailing Address - Phone:706-845-4045
Mailing Address - Fax:706-845-4312
Practice Address - Street 1:405 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-1883
Practice Address - Country:US
Practice Address - Phone:770-832-7048
Practice Address - Fax:770-830-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER