MEDICARE: POSITIVE PATHWAYS BHS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760172993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PATHWAYS BHS

Provider Business Mailing Address
First Line	:	1021 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1007
Country	:	US
Telephone Number	:	909-762-9346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1007
Country	:	US
Telephone Number	:	909-762-9346
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEALUNTA GASKIN
Credential	:
Telephone Number	:	909-762-9346

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/10/2023

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Directions to “POSITIVE PATHWAYS BHS ” Practice Location

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