Healthcare Provider Details

I. General information

NPI: 1891793543
Provider Name (Legal Business Name): PATHWAYS HEALTHCARE PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PIERCE ST STE 308
KINGSTON PA
18704
US

IV. Provider business mailing address

101 STATION DR STE 240
WESTWOOD MA
02090-2336
US

V. Phone/Fax

Practice location:
  • Phone: 570-331-3360
  • Fax: 570-331-3363
Mailing address:
  • Phone: 800-939-1855
  • Fax: 570-331-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number77330500
License Number StatePA

VIII. Authorized Official

Name: MR. SEAN TALBOT
Title or Position: COO
Credential: COO
Phone: 617-481-9077