Basic Information
Provider Information | |||||||||
NPI: | 1386785186 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PATHWAYS COMMUNITY SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8337 TELEGRAPH RD STE 115 | ||||||||
Address2: |   | ||||||||
City: | PICO RIVERA | ||||||||
State: | CA | ||||||||
PostalCode: | 906604940 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5624675440 | ||||||||
FaxNumber: | 5624675553 | ||||||||
Practice Location | |||||||||
Address1: | 8337 TELEGRAPH RD STE 115 | ||||||||
Address2: |   | ||||||||
City: | PICO RIVERA | ||||||||
State: | CA | ||||||||
PostalCode: | 906604940 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5624675440 | ||||||||
FaxNumber: | 5624675553 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/12/2007 | ||||||||
LastUpdateDate: | 08/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GINTER | ||||||||
AuthorizedOfficialFirstName: | TRACY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF STATE OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 5624675440 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CBCS | ||||||||
NPICertificationDate: | 08/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.