Healthcare Provider Details

I. General information

NPI: 1881598712
Provider Name (Legal Business Name): PATH TO INDEPENDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 FARRELL CT
OLD BRIDGE NJ
08857-3450
US

IV. Provider business mailing address

111 TOWN SQUARE PL STE 1238
JERSEY CITY NJ
07310-1810
US

V. Phone/Fax

Practice location:
  • Phone: 516-701-8754
  • Fax:
Mailing address:
  • Phone: 516-701-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVA PITTS-GIRARD
Title or Position: CEO
Credential:
Phone: 516-701-8754