Provider Demographics
NPI:1275845646
Name:PATHWAYS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:PATHWAYS OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-570-1460
Mailing Address - Street 1:1161 N EL DORADO PL STE 203
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4607
Mailing Address - Country:US
Mailing Address - Phone:520-748-7108
Mailing Address - Fax:520-745-0638
Practice Address - Street 1:1161/1181 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-748-7108
Practice Address - Fax:520-745-0638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS HEALTH AND COMMUNITY SUPPRT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-13
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6480261QM0801X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ000284Medicaid