Healthcare Provider Details

I. General information

NPI: 1497378715
Provider Name (Legal Business Name): PATHWAYS COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8337 TELEGRAPH ROAD SUITE 123, 300
PICO RIVERA CA
90660-4909
US

IV. Provider business mailing address

8337 TELEGRAPH RD STE 115
PICO RIVERA CA
90660-4940
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 562-467-5440
  • Fax: 562-467-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRACY GINTER
Title or Position: DIRECTOR OF STATE OPERATIONS
Credential: MBA, CBCS
Phone: 657-465-9497