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General NPI Number Information
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NPI Number | 1215758560
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Entity Type | Organization
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Legal Business Name | PATHWAYS AUTISM CENTER LLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2489 RICE ST STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55113-0044
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Country | US
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Telephone | 651-231-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 2489 RICE ST STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55113-0044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ZAKARIA GURE
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Credential |
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Telephone | 651-231-9914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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