Provider Demographics
NPI:1508486796
Name:STAY AT HOME HOME CARE
Entity Type:Organization
Organization Name:STAY AT HOME HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HEALTH LIASON
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIVENSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING PARTNER
Authorized Official - Phone:215-768-9244
Mailing Address - Street 1:505 LAKESIDE PARK
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4078
Mailing Address - Country:US
Mailing Address - Phone:215-768-9244
Mailing Address - Fax:
Practice Address - Street 1:505 LAKESIDE PARK
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4078
Practice Address - Country:US
Practice Address - Phone:215-768-9244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44803601OtherDEPT OF HEALTH LICENCE