MEDICARE: SAFE PATHWAY MANAGEMENT, 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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1568270197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE PATHWAY MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	4422 N RAVENSWOOD AVE # 1033
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	708-809-2496
Fax Number	:	708-392-2325

Provider Business Practice Location Address
First Line	:	4422 N RAVENSWOOD AVE # 1033
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5803
Country	:	US
Telephone Number	:	708-809-2496
Fax Number	:	708-392-2325

Authorized Official
Title or Position	:	OWNER MANAGED
Name	:	KIAIRA WALTON
Credential	:
Telephone Number	:	708-809-2496

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	01/21/2025

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