Provider Demographics
NPI:1780143099
Name:STAGING STONES LLC
Entity type:Organization
Organization Name:STAGING STONES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROITORU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-698-8788
Mailing Address - Street 1:3400 NE 192ND ST APT 2106
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2459
Mailing Address - Country:US
Mailing Address - Phone:678-698-8788
Mailing Address - Fax:
Practice Address - Street 1:3400 NE 192ND ST APT 2106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2459
Practice Address - Country:US
Practice Address - Phone:678-698-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-16
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812150800Medicaid
FL812150800Medicaid