=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780740449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FSL PATHWAYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8963 W PECK DR
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85305-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-872-8944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 E THOMAS RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-5734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-285-1800
-----------------------------------------------------
Fax | 602-285-1838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE SERVICES MANAGER
-----------------------------------------------------
Name | INDRA DAYANA GARCIA CHAVEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-285-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | BH1183
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------