Healthcare Provider Details

I. General information

NPI: 1649455320
Provider Name (Legal Business Name): FAMILY PATHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2008
Last Update Date: 01/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 N HAYDEN RD SUITE A2B
SCOTTSDALE AZ
85260-2931
US

IV. Provider business mailing address

14201 N HAYDEN RD SUITE A2B
SCOTTSDALE AZ
85260-2931
US

V. Phone/Fax

Practice location:
  • Phone: 602-284-8540
  • Fax:
Mailing address:
  • Phone: 602-284-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. DON DE VALLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LPC, LICSA
Phone: 602-284-8540