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General NPI Number Information
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NPI Number | 1336740307
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Entity Type | Organization
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Legal Business Name | PATHWAYS DEVELOPMENT LLC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 3411 MARTIN AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-3533
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Country | US
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Telephone | 616-334-0686
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Fax |
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Provider Business Mailing Address
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Address Line | 3411 MARTIN AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-3533
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Country | US
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Telephone | 616-334-0686
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHNIE TYLER
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Credential |
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Telephone | 616-334-0686
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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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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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