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NPI Code Detail

MEDICARE: SUPPORTIVE PATHWAYS LLC.

MEDICARE: SUPPORTIVE PATHWAYS LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility
2251C00000XDevelopmentally Disabled Services Day Training Agency
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1164318952
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORTIVE PATHWAYS LLC.
Provider Business Mailing Address
First Line : 421 FAYETTEVILLE ST STE 1100
Second Line :
City : RALEIGH
State : NC
Zip : 27601-3000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 421 FAYETTEVILLE ST STE 1100
Second Line : SUITE 1104
City : RALEIGH
State : NC
Zip : 27601-3000
Country : US
Telephone Number : 252-999-3950
Fax Number :
Authorized Official
Title or Position : CEO
Name : MISS SHARESA RENEE GRIFFIN
Credential : MS
Telephone Number : 252-999-3950
Provider Enumeration Date : 06/17/2025
Last Update Date : 06/17/2025

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Directions to “SUPPORTIVE PATHWAYS LLC. ” Practice Location

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