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Organization
PATHWAY CAMP MITNICK LLC
Active
Organization
PATHWAY CAMP MITNICK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALESHA BOOTH (CHIEF FINANCIAL OFFICER)
(334) 464-3668
Entity
Organization
Contact information
Practice address
4436 CALUMET LOOP, JASPER, AL 35501-7845
(334) 464-3668
Mailing address
PO BOX 311206, ENTERPRISE, AL 36331-1206
(334) 464-3668
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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