Basic Information
| Provider Information | |||||||||
| NPI: | 1851421713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHWAYS COMMUNITY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8337 TELEGRAPH ROAD | ||||||||
| Address2: | SUITE 123, 300 | ||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906604940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624675440 | ||||||||
| FaxNumber: | 5624675553 | ||||||||
| Practice Location | |||||||||
| Address1: | 8337 TELEGRAPH ROAD | ||||||||
| Address2: | SUITE 123, 300 | ||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906604940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628653644 | ||||||||
| FaxNumber: | 5628655244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | GINTER | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF STATE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7145036880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CBCS | ||||||||
| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7572D | 01 | CA | LA COUNTY REPORTING UNIT | OTHER | 7572 | 01 | CA | MEDI-CAL PROVIDER NUMBER | OTHER | 7711A | 01 | CA | LA COUNTY REPORTING UNIT | OTHER | 7572B | 01 | CA | LA COUNTY REPORTING UNIT | OTHER | 7572A | 01 | CA | LA COUNTY REPORTING UNIT | OTHER |