Provider Demographics
NPI:1184014573
Name:OPEN PATHWAYS LEARNING CENTER LLC
Entity Type:Organization
Organization Name:OPEN PATHWAYS LEARNING CENTER LLC
Other - Org Name:FORT COLLINS COMMUNITY ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-689-7281
Mailing Address - Street 1:383 W DRAKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2884
Mailing Address - Country:US
Mailing Address - Phone:970-282-8300
Mailing Address - Fax:
Practice Address - Street 1:383 W DRAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2884
Practice Address - Country:US
Practice Address - Phone:970-282-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171100000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization