Healthcare Provider Details

I. General information

NPI: 1336740307
Provider Name (Legal Business Name): PATHWAYS DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 07/29/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 MARTIN AVE
GREENSBORO NC
27405-3533
US

IV. Provider business mailing address

3411 MARTIN AVE
GREENSBORO NC
27405-3533
US

V. Phone/Fax

Practice location:
  • Phone: 616-334-0686
  • Fax:
Mailing address:
  • Phone: 616-334-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: JOHNIE TYLER
Title or Position: OWNER
Credential:
Phone: 616-334-0686