Provider Demographics
NPI:1679697668
Name:PATHWAYS TO FREEDOM
Entity type:Organization
Organization Name:PATHWAYS TO FREEDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-426-6308
Mailing Address - Street 1:208 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3848
Mailing Address - Country:US
Mailing Address - Phone:701-426-6308
Mailing Address - Fax:
Practice Address - Street 1:208 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3848
Practice Address - Country:US
Practice Address - Phone:701-426-6308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1181324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27175OtherBCBSND PROVIDER NUMBER
ND98915OtherBCBSND PROVIDER NUMBER
ND6853001OtherBCBSND CLINIC NUMBER
ND1181OtherFACILITY LICENSURE
ND98916OtherBCBSND PROVIDER NUMBER