Provider Demographics
NPI:1013738335
Name:PATHWAYS SUPPORTIVE RETREAT LLC
Entity type:Organization
Organization Name:PATHWAYS SUPPORTIVE RETREAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ALEXAUNDRA
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:317-332-2462
Mailing Address - Street 1:2931 PERCHERON LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-9116
Mailing Address - Country:US
Mailing Address - Phone:317-480-2144
Mailing Address - Fax:
Practice Address - Street 1:2931 PERCHERON LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-9116
Practice Address - Country:US
Practice Address - Phone:317-480-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty