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General NPI Number Information
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NPI Number | 1992476642
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Entity Type | Organization
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Legal Business Name | COMPASSION PATHWAY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 5410 WHITE LOTUS WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-4354
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Country | US
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Telephone | 916-870-9676
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 WHITE LOTUS WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-4354
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Country | US
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Telephone | 916-870-9676
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. IFEANYI VALLEY EZEANI
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Credential |
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Telephone | 916-870-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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