Healthcare Provider Details

I. General information

NPI: 1477987311
Provider Name (Legal Business Name): PATHWAY FOR SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 N CALLE QUINTO
HUACHUCA CITY AZ
85616-8204
US

IV. Provider business mailing address

999 E FRY BLVD STE 313
SIERRA VISTA AZ
85635-2621
US

V. Phone/Fax

Practice location:
  • Phone: 919-538-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANITA BLACKWELL
Title or Position: CEO
Credential:
Phone: 919-538-7701