Provider Demographics
NPI:1962158204
Name:PATHWAYS 1 SOBER LIVING
Entity type:Organization
Organization Name:PATHWAYS 1 SOBER LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LECAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-412-6812
Mailing Address - Street 1:1033 N SOLDANO AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2136
Mailing Address - Country:US
Mailing Address - Phone:626-412-6812
Mailing Address - Fax:
Practice Address - Street 1:126 N GLENDORA AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3341
Practice Address - Country:US
Practice Address - Phone:626-412-6812
Practice Address - Fax:626-387-9132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS 1 SOBER LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder