Provider Demographics
NPI:1497319214
Name:PATHWAYS REAL LIFE RECOVERY
Entity Type:Organization
Organization Name:PATHWAYS REAL LIFE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:LSUDC
Authorized Official - Phone:801-856-7836
Mailing Address - Street 1:8706 S 700 E STE 205
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1809
Mailing Address - Country:US
Mailing Address - Phone:801-277-7591
Mailing Address - Fax:
Practice Address - Street 1:189 E CENTER ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:UT
Practice Address - Zip Code:84730-7783
Practice Address - Country:US
Practice Address - Phone:801-856-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health