MEDICARE: PATHEWAY LIFE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	343900000X	Non-emergency Medical Transport (VAN)
4	385H00000X	Respite Care
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1558190819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHEWAY LIFE

Provider Business Mailing Address
First Line	:	3379 PEACHTREE RD NE STE 756
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1031
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15411 W WADDELL RD STE 102
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-5170
Country	:	US
Telephone Number	:	708-698-0033
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHUPAL CRUMP
Credential	:
Telephone Number	:	708-698-0033

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “PATHEWAY LIFE ” Practice Location

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