MEDICARE: PATHWAY HEALTH & WELLNESS, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1932892064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 25465
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29224-5465
Country	:	US
Telephone Number	:	843-230-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	8502 TWO NOTCH RD STE J-7
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6307
Country	:	US
Telephone Number	:	803-888-6115
Fax Number	:	803-745-8325

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OPERATIONS
Name	:	RASHEA DEVAUGHN
Credential	:
Telephone Number	:	803-888-6115

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/05/2023

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