Provider Demographics
NPI:1932922853
Name:PATHWAYS SUPPORTED LIVING
Entity type:Organization
Organization Name:PATHWAYS SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRONK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-540-3597
Mailing Address - Street 1:6250 ROYALTON DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8067
Mailing Address - Country:US
Mailing Address - Phone:616-540-3597
Mailing Address - Fax:
Practice Address - Street 1:4575 ALDUN RIDGE AVE NW # 110A
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9012
Practice Address - Country:US
Practice Address - Phone:616-540-3597
Practice Address - Fax:616-449-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty