Provider Demographics
NPI:1497862098
Name:PATHWAY FAMILY CENTER
Entity Type:Organization
Organization Name:PATHWAY FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EHLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-443-0105
Mailing Address - Street 1:6405 CASTLEWAY CT.
Mailing Address - Street 2:STE. 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-585-6953
Mailing Address - Fax:586-465-0109
Practice Address - Street 1:6405 CASTLEWAY CT.
Practice Address - Street 2:STE. 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-585-6953
Practice Address - Fax:586-465-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630740261QR0405X
IN1400-0-ASR261QR0405X
OH12497261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20498OtherBCBSM
IN000000308672OtherANTHEM BLUE CROSS