Provider Demographics
NPI:1861165557
Name:CREWPATHWAY SUPPORT SERVICES
Entity type:Organization
Organization Name:CREWPATHWAY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:813-586-3206
Mailing Address - Street 1:603 APOLLO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2121
Mailing Address - Country:US
Mailing Address - Phone:262-707-2971
Mailing Address - Fax:
Practice Address - Street 1:1101 E CUMBERLAND AVE # 726
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4231
Practice Address - Country:US
Practice Address - Phone:813-586-3206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services