=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568941524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEP THREE SUPPORT SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2018
-----------------------------------------------------
Last Update Date | 08/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1297 CENTENNIAL AVE STE 5-102
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-632-7369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1297 CENTENNIAL AVE STE 5-102
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-632-7369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JACQUELINE LITTLEJOHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-632-7369
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------