Provider Demographics
NPI:1427404789
Name:PATH-CO, LLC
Entity Type:Organization
Organization Name:PATH-CO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KISSELBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:MAE
Authorized Official - Phone:970-985-9999
Mailing Address - Street 1:241 GRAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2426
Mailing Address - Country:US
Mailing Address - Phone:970-985-9999
Mailing Address - Fax:
Practice Address - Street 1:241 GRAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2426
Practice Address - Country:US
Practice Address - Phone:970-985-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services