Provider Demographics
NPI:1891914040
Name:PATHWAYS OF SOUTHWESTERN PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:PATHWAYS OF SOUTHWESTERN PENNSYLVANIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-229-0851
Mailing Address - Street 1:655 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4118
Mailing Address - Country:US
Mailing Address - Phone:724-229-0851
Mailing Address - Fax:724-229-9252
Practice Address - Street 1:655 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4118
Practice Address - Country:US
Practice Address - Phone:724-229-0851
Practice Address - Fax:724-229-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000015200017Medicaid