1780457945 NPI number — BEHAVIORAL PATHWAYS, IMC.

Table of content: (NPI 1780457945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780457945 NPI number — BEHAVIORAL PATHWAYS, IMC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL PATHWAYS, IMC.
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:
BEHAVIORAL PATHWAYS
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:
1780457945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11930 AMARGOSA RD. SUITE 1
Provider Second Line Business Mailing Address:
#1037
Provider Business Mailing Address City Name:
VICTORVILLLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-974-4496
Provider Business Mailing Address Fax Number:
213-214-0629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4841 W AVE. L14 APT. 10
Provider Second Line Business Practice Location Address:
#1037
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-4496
Provider Business Practice Location Address Fax Number:
213-214-0629
Provider Enumeration Date:
10/31/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER/SUPERVISOR
Authorized Official Telephone Number:
661-974-4496

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)