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General NPI Number Information
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NPI Number | 1649501081
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Entity Type | Organization
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Legal Business Name | PATHWAY TO A LASTING RECOVERY
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 1701 S 1ST AVE SUITE# 310
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City | MAYWOOD
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State | IL
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Zip | 60153-2442
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Country | US
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Telephone | 708-344-0884
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Fax | 708-343-5629
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Provider Business Mailing Address
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Address Line | 1701 S 1ST AVE SUITE# 310
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City | MAYWOOD
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State | IL
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Zip | 60153-2442
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Country | US
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Telephone | 708-344-0884
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Fax | 708-343-5629
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANK MICHAEL JORDAN
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Credential | MA CADC
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Telephone | 708-344-0884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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