MEDICARE: PATHWAY TO PROMISE 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1912862020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY TO PROMISE LLC

Provider Business Mailing Address
First Line	:	3611 ARKLOW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6748
Country	:	US
Telephone Number	:	347-693-6691
Fax Number	:	347-693-6691

Provider Business Practice Location Address
First Line	:	10401 LANDON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-9691
Country	:	US
Telephone Number	:	347-693-6691
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHON FARRER
Credential	:
Telephone Number	:	347-693-6691

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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Directions to “PATHWAY TO PROMISE LLC ” Practice Location

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