Healthcare Provider Details

I. General information

NPI: 1134744360
Provider Name (Legal Business Name): A PATH TO A NEW WORLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11242 N 19TH AVE STE 24
PHOENIX AZ
85029-4857
US

IV. Provider business mailing address

11242 N 19TH AVE STE 24
PHOENIX AZ
85029-4857
US

V. Phone/Fax

Practice location:
  • Phone: 602-535-6001
  • Fax:
Mailing address:
  • Phone: 602-535-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHARIKA DAVIDSON
Title or Position: OWNER
Credential:
Phone: 602-535-6001