Provider Demographics
NPI:1336424803
Name:PEDIATRIC STARS PPECC, LLC
Entity Type:Organization
Organization Name:PEDIATRIC STARS PPECC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/NURSING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:484-426-6724
Mailing Address - Street 1:5237 BLUE SKY DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9113
Mailing Address - Country:US
Mailing Address - Phone:484-426-6724
Mailing Address - Fax:
Practice Address - Street 1:5237 BLUE SKY DRIVE
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069
Practice Address - Country:US
Practice Address - Phone:484-860-2764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251J00000X
261QM3000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No251J00000XAgenciesNursing Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric