=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881598712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATH TO INDEPENDENCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1608 FARRELL CT
-----------------------------------------------------
City | OLD BRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08857-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-701-8754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 TOWN SQUARE PL STE 1238
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07310-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-701-8754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KEVA PITTS-GIRARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-701-8754
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------