NPIMap

Organization Active NPI

Pathways Assisted Living and Memory Care, LLC

  • Assisted Living Facility
  • Goodyear, AZ
National Provider Identifier
1457735110
Registry record updated Jul 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL9477H Issued in AZ
Legal business name
PATHWAYS ASSISTED LIVING AND MEMORY CARE, LLC
Practice address
4211 N Pebble Creek Pkwy BLDG 3
Goodyear, AZ 85395-9016
Phone
(602) 633-2300
Fax
(623) 594-9164
NPI assigned
Jul 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2015

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

Authorized official

Name
John Stiteler
Title
Owner/Manager
Phone
(602) 944-1177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL9477H AZ Primary

Addresses

Primary practice location

4211 N Pebble Creek Pkwy BLDG 3
Goodyear, AZ 85395-9016

Mailing address

4211 N Pebble Creek Pkwy BLDG 3
Goodyear, AZ 85395-9016
Phone (602) 633-2300

Other identifiers 1

IdentifierTypeStateIssuer
019969MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Pathways Assisted Living Memory Care LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

4211 N Pebble Creek Pkwy
Bldg 3
Goodyear, AZ 85395
Phone (602) 633-2300

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1457735110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 N PEBBLE CREEK PKWY BLDG 3",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959016",
            "telephone_number": "602-633-2300",
            "fax_number": "623-594-9164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 N PEBBLE CREEK PKWY BLDG 3",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959016",
            "telephone_number": "602-633-2300",
            "fax_number": "623-594-9164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAYS ASSISTED LIVING AND MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "STITELER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "602-944-1177"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "AL9477H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019969",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.