Provider Demographics
NPI:1720659816
Name:PATHWAYS 1 SOBER LIVING
Entity Type:Organization
Organization Name:PATHWAYS 1 SOBER LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LECAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-412-6812
Mailing Address - Street 1:13312 RANCHERO RD # 18-168
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-4812
Mailing Address - Country:US
Mailing Address - Phone:626-373-6006
Mailing Address - Fax:
Practice Address - Street 1:1033 N SOLDANO AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2136
Practice Address - Country:US
Practice Address - Phone:626-515-6424
Practice Address - Fax:626-515-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility