Healthcare Provider Details

I. General information

NPI: 1457668741
Provider Name (Legal Business Name): STAGES FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 RT 940 SUITE 334
MT. POCONO PA
18344
US

IV. Provider business mailing address

413 RT 940 SUITE 334
MT. POCONO PA
18344
US

V. Phone/Fax

Practice location:
  • Phone: 347-277-7524
  • Fax: 570-894-8316
Mailing address:
  • Phone: 347-277-7524
  • Fax: 570-894-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StatePA

VIII. Authorized Official

Name: MRS. SHARON PURVIS
Title or Position: DIRECTOR
Credential: MSW
Phone: 347-277-7524