Provider Demographics
NPI:1912708884
Name:PEACEFUL PATHWAYS, INC
Entity type:Organization
Organization Name:PEACEFUL PATHWAYS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-280-4099
Mailing Address - Street 1:8780 19TH ST STE 164
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:909-280-4099
Mailing Address - Fax:
Practice Address - Street 1:473 E. CARNEGIE DRIVE, STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-280-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty