# PATHWAY CAMP MITNICK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306662903
- **Authorized official:** ALESHA BOOTH (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (334) 464-3668

## Contact information

- **Practice address:** 4436 CALUMET LOOP, JASPER, AL 35501-7845
- **Practice address phone:** (334) 464-3668
- **Mailing address:** PO BOX 311206, ENTERPRISE, AL 36331-1206
- **Mailing address phone:** (334) 464-3668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/27/2024
- **Last updated:** 11/27/2024