1790813822 NPI number — ABILITY PATHWAYS INC

Table of content: (NPI 1790813822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790813822 NPI number — ABILITY PATHWAYS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABILITY PATHWAYS 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:
6
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:
1790813822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1042 N MOUNTAIN AVE # B-477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-982-2991
Provider Business Mailing Address Fax Number:
909-981-0296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9003 TERHUNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91352-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-504-9134
Provider Business Practice Location Address Fax Number:
909-981-0296
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-240-7680

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  960000511 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LTC60161I , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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