Healthcare Provider Details

I. General information

NPI: 1861106676
Provider Name (Legal Business Name): A PATH TO TRANQUILITY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 E BRENTRUP DR
TEMPE AZ
85283-4701
US

IV. Provider business mailing address

3861 N 35TH ST
MILWAUKEE WI
53216-3002
US

V. Phone/Fax

Practice location:
  • Phone: 480-276-1692
  • Fax:
Mailing address:
  • Phone: 602-419-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHANDON WARD
Title or Position: MANAGING OWNER
Credential:
Phone: 480-376-6340