MEDICARE: SPECIALIZED ASSISTIVE RESIDENTIAL AND HABILATION SERVICES 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42723601	OTHER	PA	HOME CARE AGENCY FACILITY

General Provider Information

NPI Number	:	1679116628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED ASSISTIVE RESIDENTIAL AND HABILATION SERVICES LLC

Provider Business Mailing Address
First Line	:	3308 ROUTE 940 STE 104-339
Second Line	:
City	:	MOUNT POCONO
State	:	PA
Zip	:	18344-1183
Country	:	US
Telephone Number	:	866-472-7247
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 INDIAN WAY
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-7901
Country	:	US
Telephone Number	:	866-472-7247
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. DARYL THOMAS
Credential	:
Telephone Number	:	866-472-7247

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/23/2019

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