Healthcare Provider Details

I. General information

NPI: 1053964551
Provider Name (Legal Business Name): A NEW PATH TREATMENT CENTERS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42080 W SOMERSET DR
MARICOPA AZ
85138-3277
US

IV. Provider business mailing address

42080 W SOMERSET DR
MARICOPA AZ
85138-3277
US

V. Phone/Fax

Practice location:
  • Phone: 336-816-0343
  • Fax:
Mailing address:
  • Phone: 336-816-0343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CONSTANCE B POLITE
Title or Position: OWNER
Credential:
Phone: 336-816-0343