MEDICARE: FSL PATHWAYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	BH4104	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH4104	OTHER	AZ	ARIZONA BEHAVIORAL HEALTH SERVICES LICENSE

General Provider Information

NPI Number	:	1083967376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FSL PATHWAYS

Provider Business Mailing Address
First Line	:	1201 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-5734
Country	:	US
Telephone Number	:	602-285-0505
Fax Number	:	602-288-1838

Provider Business Practice Location Address
First Line	:	4023 W HAYWARD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5749
Country	:	US
Telephone Number	:	602-285-0505
Fax Number	:	602-285-1838

Authorized Official
Title or Position	:	ADMINISTRATIVE SERVICES MANAGER
Name	:	INDRA DAYANA GARCIA CHAVEZ
Credential	:
Telephone Number	:	602-285-0505

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	12/17/2025

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Directions to “FSL PATHWAYS ” Practice Location

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