1932860483 NPI number — PATHLIGHT NEUROPSYCHIATRIC CENTER LLC

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 1932860483 NPI number — PATHLIGHT NEUROPSYCHIATRIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHLIGHT NEUROPSYCHIATRIC CENTER 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:
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:
1932860483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7351 E LOWRY BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80230-6083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 BOREN AVE STE 802
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-214-9321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPEL
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING MANAGER
Authorized Official Telephone Number:
425-214-9321

Provider Taxonomy Codes

  • Taxonomy code: 2084B0040X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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