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General NPI Number Information
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NPI Number | 1205792520
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Entity Type | Organization
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Legal Business Name | PATHWAY COMMUNITY LIVING, LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1183 UNIVERSITY DR # 105-1031
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City | BURLINGTON
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State | NC
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Zip | 27215-8303
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Country | US
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Telephone | 919-290-4785
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Fax |
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Provider Business Mailing Address
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Address Line | 1183 UNIVERSITY DR # 105-1031
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City | BURLINGTON
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State | NC
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Zip | 27215-8303
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Country | US
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Telephone | 919-290-4785
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | TYQUAN CARR
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Credential |
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Telephone | 336-524-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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