=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104247659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHWAYS COMMUNITY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2013
-----------------------------------------------------
Last Update Date | 07/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6160 MISSION GORGE RD STE 100
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92120-3425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-481-3790
-----------------------------------------------------
Fax | 619-481-3797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8337 TELEGRAPH RD STE 300
-----------------------------------------------------
City | PICO RIVERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90660-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-467-5440
-----------------------------------------------------
Fax | 562-467-5553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF STATE OPERATIONS
-----------------------------------------------------
Name | TRACY GINTER
-----------------------------------------------------
Credential | MBA, CBCS
-----------------------------------------------------
Telephone | 657-465-9497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------