Provider Demographics
NPI:1790446748
Name:ADU, STEPHEN A
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:ADU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RIDINGS CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1808
Mailing Address - Country:US
Mailing Address - Phone:512-919-0131
Mailing Address - Fax:
Practice Address - Street 1:201 RIDINGS CIR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1808
Practice Address - Country:US
Practice Address - Phone:512-919-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA60783601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA60783601OtherHOME CARE AGENCY NUMBER