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General NPI Number Information
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NPI Number | 1336424803
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Entity Type | Organization
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Legal Business Name | PEDIATRIC STARS PPECC, LLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 07/14/2024
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Provider Practice Location Address
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Address Line | 2437 PLAZA CT
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City | BATH
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State | PA
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Zip | 18014-8762
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Country | US
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Telephone | 610-365-2252
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Fax | 610-365-2355
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Provider Business Mailing Address
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Address Line | 5237 BLUE SKY DR
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City | OREFIELD
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State | PA
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Zip | 18069-9113
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Country | US
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Telephone | 484-426-6724
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Fax |
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Authorized Official
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Title or Position | OPERATOR/NURSING ADMINISTRATOR
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Name | ERICA CONTRERAS
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Credential | RN
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Telephone | 484-426-6724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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