Provider Demographics
NPI:1912197773
Name:STEP BY STEP INC
Entity Type:Organization
Organization Name:STEP BY STEP INC
Other - Org Name:STEP BY STEP PRINGLE ST 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 BUILDING
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 1:270 PRINGLE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-2743
Practice Address - Country:US
Practice Address - Phone:570-829-3477
Practice Address - Fax:570-829-4090
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
PA608790315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000013970223OtherDPW PROMISE MASTER PROVID