Healthcare Provider Details

I. General information

NPI: 1104763036
Provider Name (Legal Business Name): PATHWAY PROFESSIONALS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5144 WOODLEY AVE
ENCINO CA
91436-1443
US

IV. Provider business mailing address

5144 WOODLEY AVE
ENCINO CA
91436-1443
US

V. Phone/Fax

Practice location:
  • Phone: 949-329-3473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: NEIL SHAH
Title or Position: OWNER
Credential: MD
Phone: 818-414-7765