Provider Demographics
NPI:1194018143
Name:PATHWAYS REAL LIFE RECOVERY
Entity Type:Organization
Organization Name:PATHWAYS REAL LIFE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-867-3550
Mailing Address - Street 1:1098 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9366
Mailing Address - Country:US
Mailing Address - Phone:801-867-3550
Mailing Address - Fax:801-308-8947
Practice Address - Street 1:1098 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9366
Practice Address - Country:US
Practice Address - Phone:801-867-3550
Practice Address - Fax:801-308-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health