1942084561 NPI number — MULTIPLE PATHWAYS TO RECOVERY 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 1942084561 NPI number — MULTIPLE PATHWAYS TO RECOVERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTIPLE PATHWAYS TO RECOVERY 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:
1942084561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
634 COBBLESTONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46123-8749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-939-3393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3039 N POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46226-6543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-939-3393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BECKTEMBA
Authorized Official First Name:
MINKAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-939-3393

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com