MEDICARE: PATHWAY COMMUNITY LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1205792520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY COMMUNITY LIVING, LLC

Provider Business Mailing Address
First Line	:	1183 UNIVERSITY DR # 105-1031
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8303
Country	:	US
Telephone Number	:	919-290-4785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1183 UNIVERSITY DR # 105-1031
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8303
Country	:	US
Telephone Number	:	919-290-4785
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	TYQUAN CARR
Credential	:
Telephone Number	:	336-524-3543

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	01/02/2026

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