Provider Demographics
NPI:1891793543
Name:PATHWAYS HEALTHCARE PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:PATHWAYS HEALTHCARE PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOT
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:617-481-9077
Mailing Address - Street 1:101 STATION DR STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2336
Mailing Address - Country:US
Mailing Address - Phone:800-939-1855
Mailing Address - Fax:570-331-3363
Practice Address - Street 1:270 PIERCE ST STE 308
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-331-3360
Practice Address - Fax:570-331-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA77330500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001746540Medicaid
PA397733Medicare ID - Type UnspecifiedHOME HEALTH AGENCY