Healthcare Provider Details

I. General information

NPI: 1922961408
Provider Name (Legal Business Name): PASEO AVENUES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 25TH ST
OKLAHOMA CITY OK
73106-5619
US

IV. Provider business mailing address

901 NW 25TH ST
OKLAHOMA CITY OK
73106-5619
US

V. Phone/Fax

Practice location:
  • Phone: 405-724-8908
  • Fax:
Mailing address:
  • Phone: 405-724-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: KINGSLEY TAZINYA
Title or Position: OWNER/CEO
Credential:
Phone: 301-795-5206