Provider Demographics
NPI:1316359094
Name:PRIME PATHWAYS CORPORATION, INC.
Entity Type:Organization
Organization Name:PRIME PATHWAYS CORPORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-375-5601
Mailing Address - Street 1:2153 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1446
Mailing Address - Country:US
Mailing Address - Phone:213-375-5601
Mailing Address - Fax:909-981-6292
Practice Address - Street 1:2153 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1446
Practice Address - Country:US
Practice Address - Phone:213-375-5601
Practice Address - Fax:909-981-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120101261QR0400X, 273Y00000X, 282N00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No273Y00000XHospital UnitsRehabilitation Unit
No283X00000XHospitalsRehabilitation Hospital