Organization
PATHWAYS OF IDAHO, LLC
Active
Parent organization
PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC
Other names
Clarvida
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATHWAYS HEALTH AND COMMUNITY SUPPORT, LLC
Authorized official
MR. RYAN JONES (IDAHO STATE DIRECTOR)
(208) 322-1026
Entity
Organization
Contact information
Practice address
545 N BENJAMIN LN STE 185, BOISE, ID 83704-9625
(208) 322-1026
(208) 322-1029
Mailing address
545 N BENJAMIN LN STE 185, BOISE, ID 83704-9625
(208) 322-1026
(208) 322-1029
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20004720
MEDICARE PTAN
ID
Enumeration date
04/01/2014
Last updated
06/20/2024
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