Provider Demographics
NPI:1073725859
Name:ARIZONA PATHWAYS OF LIFE, UNITY AND LOVE
Entity Type:Organization
Organization Name:ARIZONA PATHWAYS OF LIFE, UNITY AND LOVE
Other - Org Name:ARIZONA PATHWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:602-264-3045
Mailing Address - Street 1:2307 W DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4809
Mailing Address - Country:US
Mailing Address - Phone:602-264-3045
Mailing Address - Fax:602-265-3814
Practice Address - Street 1:4531 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2820
Practice Address - Country:US
Practice Address - Phone:602-484-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2742324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility