Provider Demographics
NPI:1750997003
Name:AZEVEDO INC DBA THE PATHWAY PROGRAM
Entity type:Organization
Organization Name:AZEVEDO INC DBA THE PATHWAY PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LOCKE
Authorized Official - Last Name:AZEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-921-4050
Mailing Address - Street 1:2036 N GILBERT RD STE 2-262
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2139
Mailing Address - Country:US
Mailing Address - Phone:602-568-9735
Mailing Address - Fax:
Practice Address - Street 1:3900 ROCKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2708
Practice Address - Country:US
Practice Address - Phone:602-568-9735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty