=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215427885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAYS ASSISTED LIVING & MEMORY CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4211 N PEBBLE CREEK PKWY # 789
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85395-9016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-633-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1599 E ORANGEWOOD AVE STE 250
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85020-5161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-994-1177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JOEY FRENCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-344-1177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10650C
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------