Healthcare Provider Details

I. General information

NPI: 1912862020
Provider Name (Legal Business Name): PATHWAY TO PROMISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 LANDON ST
CHARLOTTE NC
28215-9691
US

IV. Provider business mailing address

3611 ARKLOW RD
CHARLOTTE NC
28269-6748
US

V. Phone/Fax

Practice location:
  • Phone: 347-693-6691
  • Fax:
Mailing address:
  • Phone: 347-693-6691
  • Fax: 347-693-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHON FARRER
Title or Position: OWNER
Credential:
Phone: 347-693-6691