Provider Demographics
NPI:1669751616
Name:PATHWAY HOSPICE, LLC
Entity type:Organization
Organization Name:PATHWAY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-312-6825
Mailing Address - Street 1:355 WOODRUFF RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3494
Mailing Address - Country:US
Mailing Address - Phone:864-312-6825
Mailing Address - Fax:643-126-8128
Practice Address - Street 1:355 WOODRUFF RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3494
Practice Address - Country:US
Practice Address - Phone:864-312-6825
Practice Address - Fax:864-312-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-0147315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP133Medicaid
SCHPC0147OtherSTATE LICENSING FOR HOSPICE IS DEPARTMENT OF HEALTH & ENVIROMENTAL CONTROL
SC421611OtherHOSPICE AND PALLIATIVE CARE