Provider Demographics
NPI:1174785737
Name:PATHWAY ACADEMY, LLC
Entity type:Organization
Organization Name:PATHWAY ACADEMY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS AND MARKETING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-444-0794
Mailing Address - Street 1:PO BOX 160623
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84016-0623
Mailing Address - Country:US
Mailing Address - Phone:801-444-0794
Mailing Address - Fax:801-444-0793
Practice Address - Street 1:1904 W GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7232
Practice Address - Country:US
Practice Address - Phone:801-444-0794
Practice Address - Fax:801-444-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14066323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility