Provider Demographics
NPI:1912188418
Name:JENNIFER TYLER
Entity Type:Organization
Organization Name:JENNIFER TYLER
Other - Org Name:PATHWAYS ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-252-9947
Mailing Address - Street 1:45864 INLET BREEZE ST
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9679
Mailing Address - Country:US
Mailing Address - Phone:907-252-9947
Mailing Address - Fax:907-335-2994
Practice Address - Street 1:45864 INLET BREEZE ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9679
Practice Address - Country:US
Practice Address - Phone:907-252-9947
Practice Address - Fax:907-335-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100651310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility