Provider Demographics
NPI:1528304136
Name:PATHWAYS TO ACHIEVEMENT INC
Entity type:Organization
Organization Name:PATHWAYS TO ACHIEVEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EHNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN BA MA
Authorized Official - Phone:218-721-4732
Mailing Address - Street 1:114 S 20TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-3526
Mailing Address - Country:US
Mailing Address - Phone:218-721-4732
Mailing Address - Fax:218-491-7185
Practice Address - Street 1:2016 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-3524
Practice Address - Country:US
Practice Address - Phone:187-214-7322
Practice Address - Fax:218-491-7185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS TO ACHIEVEMENT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-31
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09029Medicare UPIN