Provider Demographics
NPI:1326466988
Name:PATHWAYS OF IDAHO, LLC
Entity Type:Organization
Organization Name:PATHWAYS OF IDAHO, LLC
Other - Org Name:ACES COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IDAHO STATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-322-1026
Mailing Address - Street 1:545 N BENJAMIN LN STE 185
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9625
Mailing Address - Country:US
Mailing Address - Phone:208-322-1026
Mailing Address - Fax:208-322-1029
Practice Address - Street 1:545 N BENJAMIN LN STE 185
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9625
Practice Address - Country:US
Practice Address - Phone:208-322-1026
Practice Address - Fax:208-322-1029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-01
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20004720OtherMEDICARE PTAN
IDID05400Medicare PIN