MEDICARE: PATHWAY RECOVERY

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
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1538027321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY RECOVERY

Provider Business Mailing Address
First Line	:	3254 STINSON BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2340
Country	:	US
Telephone Number	:	612-670-4849
Fax Number	:

Provider Business Practice Location Address
First Line	:	3254 STINSON BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-2340
Country	:	US
Telephone Number	:	612-670-4849
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/OPERATOR
Name	:	KALEAB TEWODROS WOLDEGIORGIS
Credential	:	CPRS-F
Telephone Number	:	612-670-4849

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “PATHWAY RECOVERY ” Practice Location

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