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1750997003 NPI number — AZEVEDO INC DBA THE PATHWAY PROGRAM

NPI Number: 1750997003
Health Care Provider/Practitioner: AZEVEDO INC DBA THE PATHWAY PROGRAM

Information about “1750997003” NPI (AZEVEDO INC DBA THE PATHWAY PROGRAM) exists in 1750997003 in HTML format HTML  |  1750997003 in plain Text format TXT  |  1750997003 in PDF (Portable Document Format) PDF  |  1750997003 in an XML format XML  formats.

NPI Number : 1750997003 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750997003",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "AZEVEDO INC DBA THE PATHWAY PROGRAM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2036 N GILBERT RD STE 2-262",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MESA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85203-2139",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-568-9735",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3900 ROCKLIN RD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROCKLIN",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95677-2708",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-568-9735",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2020",
    "LastUpdateDate": "05/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AZEVEDO",
    "AuthorizedOfficialFirstName": "JOSHUA",
    "AuthorizedOfficialMiddleName": "LOCKE",
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LISAC",
    "AuthorizedOfficialTelephoneNumber": "480-921-4050",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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