MEDICARE: STEPPING STONES 2 LIFE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1043565278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPING STONES 2 LIFE, LLC

Provider Business Mailing Address
First Line	:	10045 MIDLOTHIAN TPKE
Second Line	:	SUITE 201
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4857
Country	:	US
Telephone Number	:	804-591-5272
Fax Number	:

Provider Business Practice Location Address
First Line	:	10045 MIDLOTHIAN TPKE
Second Line	:	SUITE 201
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4857
Country	:	US
Telephone Number	:	804-591-5272
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MISS APRIL HUGHES
Credential	:
Telephone Number	:	804-591-5272

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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