Healthcare Provider Details

I. General information

NPI: 1194611665
Provider Name (Legal Business Name): PATHWAYS COMMUNITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 E MINNESOTA ST
INDIANAPOLIS IN
46203-2842
US

IV. Provider business mailing address

1634 E MINNESOTA ST
INDIANAPOLIS IN
46203-2842
US

V. Phone/Fax

Practice location:
  • Phone: 317-993-2473
  • Fax:
Mailing address:
  • Phone: 317-993-2473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANGEL BUMPHUS
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 317-993-2473