Healthcare Provider Details

I. General information

NPI: 1063444305
Provider Name (Legal Business Name): PATHWAYS HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

IV. Provider business mailing address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3500
  • Fax: 970-292-0898
Mailing address:
  • Phone: 970-663-3500
  • Fax: 970-292-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991100
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18947
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number18947
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number170346
License Number StateCO

VIII. Authorized Official

Name: TIM BOWEN
Title or Position: CEO
Credential:
Phone: 303-398-6226