Healthcare Provider Details

I. General information

NPI: 1356581029
Provider Name (Legal Business Name): PATHWAYS BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 10TH ST SW
WAVERLY IA
50677-2925
US

IV. Provider business mailing address

111 10TH ST SW
WAVERLY IA
50677-2925
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-2064
  • Fax:
Mailing address:
  • Phone: 319-352-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ALAN BECKER
Title or Position: BUSINESS MANAGER
Credential: CPA
Phone: 319-235-6571