Provider Demographics
NPI:1912404344
Name:MAKANA PATH LLC
Entity type:Organization
Organization Name:MAKANA PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCDC
Authorized Official - Phone:972-835-1963
Mailing Address - Street 1:11503 PARSONS RD
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-5220
Mailing Address - Country:US
Mailing Address - Phone:512-278-4550
Mailing Address - Fax:512-278-4552
Practice Address - Street 1:826 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-1279
Practice Address - Country:US
Practice Address - Phone:512-278-4550
Practice Address - Fax:512-278-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility