Provider Demographics
NPI:1922352194
Name:PATHWAY TO FREEDOM
Entity Type:Organization
Organization Name:PATHWAY TO FREEDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:701-426-6308
Mailing Address - Street 1:418 E ROSSER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4046
Mailing Address - Country:US
Mailing Address - Phone:701-426-6308
Mailing Address - Fax:
Practice Address - Street 1:418 E ROSSER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4046
Practice Address - Country:US
Practice Address - Phone:701-426-6308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1232261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder