1124371208 NPI number — PATHWAYS BEHAVIORAL SERVICES, INC.

Table of content: (NPI 1124371208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124371208 NPI number — PATHWAYS BEHAVIORAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS BEHAVIORAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124371208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3362 UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50701-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-235-6571
Provider Business Mailing Address Fax Number:
319-235-6028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50703-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-272-4300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
319-235-6571

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com