1780081174 NPI number — PATHWAYS TO A BETTER LIFE, LLC

Table of content: (NPI 1780081174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780081174 NPI number — PATHWAYS TO A BETTER LIFE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS TO A BETTER LIFE, LLC
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:
PATHWAYS TO A BETTER LIFE - KIEL CAMPUS 2
Provider Other Organization Name Type Code:
3
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:
1780081174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIEL
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53042-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-894-1374
Provider Business Mailing Address Fax Number:
920-894-3408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13111 LAX CHAPEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIEL
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53042-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-894-1374
Provider Business Practice Location Address Fax Number:
920-894-1373
Provider Enumeration Date:
12/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTIE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / CEO
Authorized Official Telephone Number:
920-286-0189

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265068415 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861022022 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053468207 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336105501 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1780262840 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659907392 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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