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General NPI Number Information
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NPI Number | 1184149361
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Entity Type | Organization
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Legal Business Name | POSITIVE PATHWAYS
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 23 S CARBON AVE SUITE 21
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City | PRICE
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State | UT
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Zip | 84501-2853
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Country | US
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Telephone | 435-299-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 23 S CARBON AVE SUITE 21
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City | PRICE
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State | UT
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Zip | 84501-2853
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Country | US
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Telephone | 435-299-5003
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Fax |
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Authorized Official
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Title or Position | PRESCRIBER/OWNER
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Name | SABRINA K CARTER
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Credential |
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Telephone | 435-299-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 10410631-0142
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License Number State | UT
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