Provider Demographics
NPI:1265898118
Name:PERSISTENT PATHWAYS, LLC.
Entity type:Organization
Organization Name:PERSISTENT PATHWAYS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:720-984-5529
Mailing Address - Street 1:126 BEACON WAY UNIT 2F
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6182
Mailing Address - Country:US
Mailing Address - Phone:720-984-5529
Mailing Address - Fax:
Practice Address - Street 1:126 BEACON WAY UNIT 2F
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6182
Practice Address - Country:US
Practice Address - Phone:720-984-5529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004447225X00000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty