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NPI Code Detail

MEDICARE: PATHWAY 33 LLC

MEDICARE: PATHWAY 33 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
1251X00000XSupports Brokerage Agency
2251E00000XHome Health Agency
3251S00000XCommunity/Behavioral Health Agency
4251C00000XDevelopmentally Disabled Services Day Training Agency
5253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1720883325
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHWAY 33 LLC
Provider Business Mailing Address
First Line : 20109 ENSLOW DR
Second Line :
City : CARSON
State : CA
Zip : 90746-3031
Country : US
Telephone Number : 310-930-0701
Fax Number :
Provider Business Practice Location Address
First Line : 2306 HOLLYWOOD DR
Second Line :
City : STOCKTON
State : CA
Zip : 95210-1626
Country : US
Telephone Number : 310-930-0701
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. MARCUS O'KEITH
Credential :
Telephone Number : 310-930-0701
Provider Enumeration Date : 02/17/2025
Last Update Date : 12/01/2025

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