Healthcare Provider Details

I. General information

NPI: 1396670188
Provider Name (Legal Business Name): PATHWAY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRAGG ST NE
WILSON NC
27893-3701
US

IV. Provider business mailing address

109 BRAGG ST NE
WILSON NC
27893-3701
US

V. Phone/Fax

Practice location:
  • Phone: 301-537-1333
  • Fax:
Mailing address:
  • Phone: 301-537-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KEYLA RAGLAND
Title or Position: OWNER
Credential:
Phone: 301-537-1333