Provider Demographics
NPI:1548648660
Name:PATHWAYS ASSISTED LIVING AND MEMORY CARE, LLC
Entity type:Organization
Organization Name:PATHWAYS ASSISTED LIVING AND MEMORY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STITELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-944-1177
Mailing Address - Street 1:1599 E ORANGEWOOD AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5161
Mailing Address - Country:US
Mailing Address - Phone:602-944-1177
Mailing Address - Fax:602-944-8899
Practice Address - Street 1:4211 N PEBBLE CREEK PKWY BLDG 4
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9016
Practice Address - Country:US
Practice Address - Phone:602-633-2300
Practice Address - Fax:623-594-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9512H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ006388Medicaid