Provider Demographics
NPI:1164318952
Name:SUPPORTIVE PATHWAYS LLC.
Entity type:Organization
Organization Name:SUPPORTIVE PATHWAYS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARESA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:252-999-3950
Mailing Address - Street 1:421 FAYETTEVILLE ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 FAYETTEVILLE ST STE 1100
Practice Address - Street 2:SUITE 1104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-3000
Practice Address - Country:US
Practice Address - Phone:252-999-3950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251C00000XAgenciesDay Training, Developmentally Disabled Services