Provider Demographics
NPI:1871569707
Name:PATHWELL CT, INC.
Entity type:Organization
Organization Name:PATHWELL CT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-256-0871
Mailing Address - Street 1:99 HAWLEY LN STE 1001
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1204
Mailing Address - Country:US
Mailing Address - Phone:203-256-1804
Mailing Address - Fax:203-259-8523
Practice Address - Street 1:99 HAWLEY LN STE 1001
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1204
Practice Address - Country:US
Practice Address - Phone:203-256-1804
Practice Address - Fax:203-259-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC9206505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V9964OtherHEALTH NET
CT004114104Medicaid
CTCU3190OtherCCS
CT1871569707OtherUNITED HEALTHCARE
CT298OtherANTHEM BLUE CROSS
CT0V9964OtherHEALTH NET
CT794736OtherCONNECTICARE