Provider Demographics
NPI:1891586624
Name:PATHWAYS ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:PATHWAYS ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-791-0397
Mailing Address - Street 1:3405 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-2833
Mailing Address - Country:US
Mailing Address - Phone:602-791-0397
Mailing Address - Fax:602-791-0397
Practice Address - Street 1:3405 N 11TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-2833
Practice Address - Country:US
Practice Address - Phone:602-791-0397
Practice Address - Fax:602-791-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility