Provider Demographics
NPI:1366658429
Name:PATHWAYS TO SUCCESS
Entity Type:Organization
Organization Name:PATHWAYS TO SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-538-7754
Mailing Address - Street 1:197 N 4700 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5912
Mailing Address - Country:US
Mailing Address - Phone:208-538-7754
Mailing Address - Fax:208-538-6042
Practice Address - Street 1:197 N 4700 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5912
Practice Address - Country:US
Practice Address - Phone:208-538-7754
Practice Address - Fax:208-538-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management