Healthcare Provider Details

I. General information

NPI: 1063578730
Provider Name (Legal Business Name): FSL PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 W SIERRA VISTA DR
GLENDALE AZ
85303-3520
US

IV. Provider business mailing address

1201 E THOMAS RD
PHOENIX AZ
85014-5734
US

V. Phone/Fax

Practice location:
  • Phone: 623-934-6166
  • Fax:
Mailing address:
  • Phone: 602-285-1800
  • Fax: 602-285-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH1181
License Number StateAZ

VIII. Authorized Official

Name: INDRA DAYANA GARCIA CHAVEZ
Title or Position: ADMINISTRATIVE SERVICES MANAGER
Credential:
Phone: 602-285-0505