Provider Demographics
NPI:1053742049
Name:PATHWAYS YOUTH SERVICES LLC
Entity type:Organization
Organization Name:PATHWAYS YOUTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-476-5059
Mailing Address - Street 1:1010 MARIONS TRL
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3126
Mailing Address - Country:US
Mailing Address - Phone:434-476-5059
Mailing Address - Fax:434-476-5060
Practice Address - Street 1:1010 MARIONS TRL
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-3126
Practice Address - Country:US
Practice Address - Phone:434-476-5059
Practice Address - Fax:434-476-5060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS YOUTH SERVICES III
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA180214001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness