Provider Demographics
NPI:1457753063
Name:ADL SUPPORT SERVICES, LLC.
Entity Type:Organization
Organization Name:ADL SUPPORT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:484-888-5208
Mailing Address - Street 1:240 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-8693
Mailing Address - Country:US
Mailing Address - Phone:484-888-5208
Mailing Address - Fax:
Practice Address - Street 1:240 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-8693
Practice Address - Country:US
Practice Address - Phone:484-888-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA102889307251C00000X, 251K00000X, 251S00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102889307OtherPERSON/FAMILY DIRECT SUPPOR WAIVER
PA102889307OtherCONSOLIDATED WAIVER
PA102889307Medicaid