# ETERNAL PATHWAY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003483447
- **Authorized official:** LINETTE WILSON (OWNER/ MANAGER)
- **Authorized official phone:** (305) 731-6917

## Contact information

- **Practice address:** 11225 N 28TH DR STE D104, PHOENIX, AZ 85029-5609
- **Practice address phone:** (602) 607-5422
- **Mailing address:** 11225 N 28TH DR STE D104, PHOENIX, AZ 85029-5609
- **Mailing address phone:** (602) 607-5422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/04/2021
- **Last updated:** 06/04/2021