Provider Demographics
NPI:1972771152
Name:YOUTH PATHWAYS LLC
Entity Type:Organization
Organization Name:YOUTH PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNIBAL
Authorized Official - Middle Name:CLITUS
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-922-1664
Mailing Address - Street 1:1401 TURNER RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6934
Mailing Address - Country:US
Mailing Address - Phone:804-271-1883
Mailing Address - Fax:804-271-1884
Practice Address - Street 1:1401 TURNER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-6934
Practice Address - Country:US
Practice Address - Phone:804-271-1883
Practice Address - Fax:804-271-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities