NPIMap

Organization Active NPI

Maitri Path to Wellness PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Peru, IL
National Provider Identifier
1053018242
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MAITRI PATH TO WELLNESS PLLC
Practice address
710 Peoria St
Peru, IL 61354-3351
Phone
(815) 780-0690
Fax
(815) 410-1937
NPI assigned
Feb 8, 2023
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenden FaskenNPI 1043991961
Title
Chief Operating Officer
Phone
(815) 780-0690

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

710 Peoria St
Peru, IL 61354-3351

Mailing address

710 Peoria St
Peru, IL 61354-3351
Phone (815) 780-0690

National Provider Directory

National Provider Directory
Tax ID family
Maitri Path to Wellness PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

111 Bucklin St
Ste 2
La Salle, IL 61301
Phone (815) 780-0690

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1053018242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 PEORIA ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543351",
            "telephone_number": "815-780-0690",
            "fax_number": "815-410-1937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 PEORIA ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543351",
            "telephone_number": "815-780-0690",
            "fax_number": "815-410-1937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAITRI PATH TO WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-08",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "FASKEN",
        "authorized_official_first_name": "BRENDEN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "815-780-0690"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peru, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.