Provider Demographics
NPI:1346017704
Name:PATHWAYS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:PATHWAYS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-842-2524
Mailing Address - Street 1:14333 N 91ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3764
Mailing Address - Country:US
Mailing Address - Phone:602-842-2524
Mailing Address - Fax:
Practice Address - Street 1:4015 E SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2225
Practice Address - Country:US
Practice Address - Phone:602-842-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility