FSL PATHWAYS , NPI 1841356615 — AGL - GARDEN in PHOENIX (AZ)

NPI 1841356615

13+ Years Experience Organization

FSL PATHWAYS

Other organization name: AGL - GARDEN.

12/28/2006
PROVIDER ENUMERATION DATE
07.09.2007
LAST UPDATE DATE
1841356615
NPI NUMBER

About FSL PATHWAYS

FSL PATHWAYS is a provider established in PHOENIX, AZ. The NPI number of FSL PATHWAYS is 1841356615 and was assigned on 12/28/2006. The practitioners primary taxonomy code is: 320800000X with license number: BH2337 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850145734
  • Phone: 6022851800
  • Fax: 6022851838
  • Address: 1201 E THOMAS RD

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1841356615
  • Phone : 6025642973
  • Postalcode : 850293828
  • Address : 3927 W GARDEN DR

Additional identifiers

  • Identifier: 346462
  • Code / Type : 5 - MEDICAID
  • Identifier state : AZ

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: BH2337
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer : ADHS BHS LICENSE

Provider taxonomy - Community Based Residential Treatment Facility, Mental Illness

  • Taxonomy code: 320800000X
  • License number: BH2337
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Contacts:

Click to Show Map
  • FSL PATHWAYS
  • Address : 3927 W GARDEN DR
  • Region : PHOENIX, AZ
  • NPI : 1841356615
  • Phone : 6025642973
  • Postalcode : 850293828

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 6022850505
  • Title or position : EXEC ASST

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address3927 W GARDEN DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850293828
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6025642973
The telephone number associated with the location address of the provider being identified.
NPI1841356615
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1320800000X
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Provider Enumeration Date12/28/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.09.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)FSL PATHWAYS
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NameAGL - GARDEN
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address1201 E THOMAS RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850145734
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6022851800
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6022851838
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameINIGUEZ
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameANNETTE
The first name of the authorized official
Authorized Official Title or PositionEXEC ASST
The title or position of the authorized official
Authorized Official Name Prefix TextMS.
Authorized Official Name Prefix Text
Authorized Official Telephone Number6022850505
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1320800000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Provider License Number 1BH2337
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1346462
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1AZ
Other Provider Identifier State #1
Other Provider Identifier 2BH2337
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2AZ
Other Provider Identifier State #2
Other Provider Identifier Issuer 2ADHS BHS LICENSE
Other Provider Identifier Issuer #2
X

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