Provider Demographics
NPI:1679116628
Name:SPECIALIZED ASSISTIVE RESIDENTIAL AND HABILATION SERVICES LLC
Entity Type:Organization
Organization Name:SPECIALIZED ASSISTIVE RESIDENTIAL AND HABILATION SERVICES LLC
Other - Org Name:SARAHS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-472-7247
Mailing Address - Street 1:3308 ROUTE 940 STE 104-339
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1183
Mailing Address - Country:US
Mailing Address - Phone:866-472-7247
Mailing Address - Fax:
Practice Address - Street 1:433 INDIAN WAY
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-7901
Practice Address - Country:US
Practice Address - Phone:866-472-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA42723601OtherHOME CARE AGENCY FACILITY