1457616062 NPI number — PATHWAY TO HOME CARE SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457616062 NPI number — PATHWAY TO HOME CARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAY TO HOME CARE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457616062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6148 LEE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 106B
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-710-1563
Provider Business Mailing Address Fax Number:
423-710-2347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6148 LEE HWY
Provider Second Line Business Practice Location Address:
SUITE 106B
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-2994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-710-1563
Provider Business Practice Location Address Fax Number:
423-710-2347
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
SVP
Authorized Official Telephone Number:
425-710-1563

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  I00000001117 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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