Provider Demographics
NPI:1205544707
Name:THE PASS PROGRAM LLC
Entity type:Organization
Organization Name:THE PASS PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-433-9600
Mailing Address - Street 1:3037 W KELLER DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1572
Mailing Address - Country:US
Mailing Address - Phone:623-512-6065
Mailing Address - Fax:480-907-2301
Practice Address - Street 1:3555 W PINNACLE PEAK RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4338
Practice Address - Country:US
Practice Address - Phone:480-433-9600
Practice Address - Fax:480-907-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy