1992134902 NPI number — PATHWAYS TO INDEPENDENCE

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 1992134902 NPI number — PATHWAYS TO INDEPENDENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS TO INDEPENDENCE
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:
1992134902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4629 CHALK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75052-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-878-1080
Provider Business Mailing Address Fax Number:
972-522-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4629 CHALK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-878-1080
Provider Business Practice Location Address Fax Number:
972-522-0291
Provider Enumeration Date:
11/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TALLEY
Authorized Official First Name:
SALENCIA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
CO OWNER
Authorized Official Telephone Number:
214-878-1080

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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