Provider Demographics
NPI:1760106678
Name:PATHWAYS PROVIDER LLC
Entity Type:Organization
Organization Name:PATHWAYS PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-654-8775
Mailing Address - Street 1:1921 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3821
Mailing Address - Country:US
Mailing Address - Phone:937-654-8775
Mailing Address - Fax:
Practice Address - Street 1:1921 KIPLING DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3821
Practice Address - Country:US
Practice Address - Phone:937-654-8775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services