Provider Demographics
NPI:1316583230
Name:PATHFINDERS RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:PATHFINDERS RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3300
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:480-718-7374
Practice Address - Street 1:34048 N 59TH WAT
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5272
Practice Address - Country:US
Practice Address - Phone:480-674-7404
Practice Address - Fax:480-718-7374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHFINDERS RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-26
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ555152Medicaid