Healthcare Provider Details

I. General information

NPI: 1780081174
Provider Name (Legal Business Name): PATHWAYS TO A BETTER LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 LAX CHAPEL RD
KIEL WI
53042-3954
US

IV. Provider business mailing address

PO BOX 347
KIEL WI
53042-0347
US

V. Phone/Fax

Practice location:
  • Phone: 920-894-1374
  • Fax: 920-894-1373
Mailing address:
  • Phone: 920-894-1374
  • Fax: 920-894-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BEATTIE
Title or Position: OWNER / CEO
Credential:
Phone: 920-286-0189