Healthcare Provider Details

I. General information

NPI: 1720883325
Provider Name (Legal Business Name): PATHWAY 33 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 HOLLYWOOD DR
STOCKTON CA
95210-1626
US

IV. Provider business mailing address

20109 ENSLOW DR
CARSON CA
90746-3031
US

V. Phone/Fax

Practice location:
  • Phone: 310-930-0701
  • Fax:
Mailing address:
  • Phone: 310-930-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCUS O'KEITH
Title or Position: OWNER
Credential:
Phone: 310-930-0701