Provider Demographics
NPI:1659437317
Name:FSL PATHWAYS
Entity type:Organization
Organization Name:FSL PATHWAYS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:DAYANA
Authorized Official - Last Name:GARCIA CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-0505
Mailing Address - Street 1:1201 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5734
Mailing Address - Country:US
Mailing Address - Phone:602-285-1800
Mailing Address - Fax:602-285-1838
Practice Address - Street 1:613 W PLATA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8330
Practice Address - Country:US
Practice Address - Phone:480-813-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH1186320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH1186OtherADHS BHS 1186
AZ346412Medicaid