Provider Demographics
NPI:1477231702
Name:GOLDEN PATH HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GOLDEN PATH HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHIA
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:ENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:910-977-6894
Mailing Address - Street 1:11022 N 28TH DR STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5636
Mailing Address - Country:US
Mailing Address - Phone:910-977-6894
Mailing Address - Fax:
Practice Address - Street 1:11022 N 28TH DR STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5636
Practice Address - Country:US
Practice Address - Phone:910-977-6894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty