MEDICARE: FSL PATHWAYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	BH1184	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	BH1184	OTHER	AZ	ADHS BHS LICENSE

General Provider Information

NPI Number	:	1619033412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FSL PATHWAYS

Provider Business Mailing Address
First Line	:	1201 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5734
Country	:	US
Telephone Number	:	602-285-1800
Fax Number	:	602-285-1838

Provider Business Practice Location Address
First Line	:	925 W FOGAL WAY
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4727
Country	:	US
Telephone Number	:	480-967-7304
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PROGRAM OFFICER
Name	:	CHARNISE MOORE
Credential	:	DRPH, MPH, CHC, CHRC
Telephone Number	:	602-285-1800

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/20/2026

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Directions to “FSL PATHWAYS ” Practice Location

Language	Start Address	Practice Location

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