Provider Demographics
NPI:1407000896
Name:INNOVATIVE PATHWAYS INC.
Entity Type:Organization
Organization Name:INNOVATIVE PATHWAYS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BAHRIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-206-2030
Mailing Address - Street 1:1534 PLAZA LN
Mailing Address - Street 2:SUITE 358
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3204
Mailing Address - Country:US
Mailing Address - Phone:510-206-2030
Mailing Address - Fax:650-259-0332
Practice Address - Street 1:14895 E 14TH ST
Practice Address - Street 2:SUITE 465
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2922
Practice Address - Country:US
Practice Address - Phone:510-206-2030
Practice Address - Fax:510-346-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency