Provider Demographics
NPI:1720267289
Name:PEDIPATHWAYS,INC.
Entity Type:Organization
Organization Name:PEDIPATHWAYS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:EDWINA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-774-1350
Mailing Address - Street 1:440 HANCOCK ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2442
Mailing Address - Country:US
Mailing Address - Phone:617-774-1355
Mailing Address - Fax:
Practice Address - Street 1:440 HANCOCK ST UNIT 206
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2442
Practice Address - Country:US
Practice Address - Phone:617-774-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1669675310Medicaid
MA1669675310Medicaid