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General NPI Number Information
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NPI Number | 1912404344
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Entity Type | Organization
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Legal Business Name | MAKANA PATH LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 826 LEXINGTON RD
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City | ELGIN
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State | TX
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Zip | 78621-1279
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Country | US
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Telephone | 512-278-4550
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Fax | 512-278-4552
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Provider Business Mailing Address
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Address Line | 11503 PARSONS RD
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City | MANOR
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State | TX
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Zip | 78653-5220
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Country | US
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Telephone | 512-278-4550
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Fax | 512-278-4552
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AMANDA KAY BAKER
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Credential | MS, LCDC
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Telephone | 972-835-1963
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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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