Provider Demographics
NPI:1497945281
Name:STEP BY STEP INC.
Entity Type:Organization
Organization Name:STEP BY STEP INC.
Other - Org Name:BUSHKILL ICF/MR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-829-3477
Mailing Address - Street 1:744 KIDDER ST
Mailing Address - Street 2:CROSS VALLEY COMMONS BLDG.
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7015
Mailing Address - Country:US
Mailing Address - Phone:570-829-3477
Mailing Address - Fax:570-829-7918
Practice Address - Street 1:471 BUSHKILL CENTER RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9533
Practice Address - Country:US
Practice Address - Phone:610-867-0688
Practice Address - Fax:610-867-9217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEP BY STEP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-27
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA45641100315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000013970207OtherDPW MASTER PROVIDER INDEX