Healthcare Provider Details

I. General information

NPI: 1770340598
Provider Name (Legal Business Name): PERSISTENT PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31586 TYME CT
MENIFEE CA
92584-3838
US

IV. Provider business mailing address

31586 TYME CT
MENIFEE CA
92584-3838
US

V. Phone/Fax

Practice location:
  • Phone: 818-860-9779
  • Fax:
Mailing address:
  • Phone: 818-860-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MS. MARQUITA BERRY
Title or Position: CEO
Credential:
Phone: 818-860-9779