Healthcare Provider Details

I. General information

NPI: 1336050574
Provider Name (Legal Business Name): PATHWELL RIDE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BLUE JAY CT
MOUNT PROSPECT IL
60056-6077
US

IV. Provider business mailing address

511 BLUE JAY CT
MOUNT PROSPECT IL
60056-6077
US

V. Phone/Fax

Practice location:
  • Phone: 847-371-1343
  • Fax:
Mailing address:
  • Phone: 847-371-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SEUNGSUP SHIN
Title or Position: OWNER
Credential:
Phone: 847-371-1343