Healthcare Provider Details

I. General information

NPI: 1679701684
Provider Name (Legal Business Name): PROVIDER OF CO-OP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 HARK A WAY RD
CHESTER SPRINGS PA
19425-2302
US

IV. Provider business mailing address

1467 HARK A WAY RD
CHESTER SPRINGS PA
19425-2302
US

V. Phone/Fax

Practice location:
  • Phone: 610-453-5005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN517919L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number102276610
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number102276610
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number102276610
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number102276610
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StatePA

VIII. Authorized Official

Name: CATHRYN LAURIE STEIN
Title or Position: OWNER
Credential:
Phone: 610-453-5005