Healthcare Provider Details

I. General information

NPI: 1962123422
Provider Name (Legal Business Name): PATHWAYS OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 E CHAPMAN AVE
FULLERTON CA
92831-3908
US

IV. Provider business mailing address

PO BOX 6326
FULLERTON CA
92834-6326
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-3691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH MCCLELLAN
Title or Position: DIRECTOR OF PROGRAMS
Credential:
Phone: 714-680-6391