Healthcare Provider Details

I. General information

NPI: 1033918156
Provider Name (Legal Business Name): CREATING A PATHWAY TO EVERYDAY LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 COUNTRY CLUB DR
LUCERNE CA
95458-8640
US

IV. Provider business mailing address

PO BOX 986
NICE CA
95464-0986
US

V. Phone/Fax

Practice location:
  • Phone: 510-691-1633
  • Fax:
Mailing address:
  • Phone: 510-691-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORREE ELLEN LEWIS CRANDELL
Title or Position: EXECUTIVE DIRECTOR / CEO
Credential:
Phone: 510-691-1633