1255477204 NPI number — COMMUNITY PATHWAYS UNLIMITED, INC.

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 1255477204 NPI number — COMMUNITY PATHWAYS UNLIMITED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY PATHWAYS UNLIMITED, 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:
1255477204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4045 NW 64TH ST
Provider Second Line Business Mailing Address:
SUITE 520
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-842-4911
Provider Business Mailing Address Fax Number:
405-842-5807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4045 NW 64TH ST
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-842-4911
Provider Business Practice Location Address Fax Number:
405-842-5807
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN HORN
Authorized Official First Name:
LAUREL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
405-842-4911

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  260 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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