Provider Demographics
NPI:1063015618
Name:STONEBROOK COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:STONEBROOK COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PRUETT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:540-562-8462
Mailing Address - Street 1:200 LUTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5720
Mailing Address - Country:US
Mailing Address - Phone:304-267-2763
Mailing Address - Fax:
Practice Address - Street 1:200 LUTZ AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5720
Practice Address - Country:US
Practice Address - Phone:304-267-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services