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General NPI Number Information
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NPI Number | 1720659816
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Entity Type | Organization
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Legal Business Name | PATHWAYS 1 SOBER LIVING
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 1033 N SOLDANO AVE
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City | AZUSA
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State | CA
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Zip | 91702-2136
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Country | US
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Telephone | 626-515-6424
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Fax | 626-515-8279
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Provider Business Mailing Address
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Address Line | 13312 RANCHERO RD # 18-168
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City | OAK HILLS
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State | CA
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Zip | 92344-4812
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Country | US
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Telephone | 626-373-6006
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | MISS MADONNA MICHELLE LECAINE
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Credential |
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Telephone | 626-412-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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