1194018143 NPI number — PATHWAYS REAL LIFE RECOVERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194018143 NPI number — PATHWAYS REAL LIFE RECOVERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS REAL LIFE RECOVERY
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:
1194018143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1098 W SOUTH JORDAN PKWY
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-9366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-867-3550
Provider Business Mailing Address Fax Number:
801-308-8947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1098 W SOUTH JORDAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095-9366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-867-3550
Provider Business Practice Location Address Fax Number:
801-308-8947
Provider Enumeration Date:
05/24/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMERMAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/FOUNDER
Authorized Official Telephone Number:
801-867-3550

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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