Provider Demographics
NPI:1497406425
Name:COMPASSION PATHWAY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:COMPASSION PATHWAY BEHAVIORAL HEALTH LLC
Other - Org Name:COMPASSION SPRINGS SRF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-870-9676
Mailing Address - Street 1:5410 WHITE LOTUS WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4354
Mailing Address - Country:US
Mailing Address - Phone:916-870-9676
Mailing Address - Fax:
Practice Address - Street 1:4229 TOYAN DR
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9702
Practice Address - Country:US
Practice Address - Phone:916-870-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness