Healthcare Provider Details

I. General information

NPI: 1982957650
Provider Name (Legal Business Name): STEP BY STEP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 HAZLE ST
WILKES BARRE PA
18702-4534
US

IV. Provider business mailing address

744 KIDDER STREET
WILKES BARRE PA
18702-7015
US

V. Phone/Fax

Practice location:
  • Phone: 570-829-3477
  • Fax: 570-829-7918
Mailing address:
  • Phone: 570-829-3477
  • Fax: 570-829-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number218960
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES L BOBECK
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential:
Phone: 570-829-3477