Individual
STEPHEN RODRIGUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRESIDENT/CEO
Contact information
Practice address
1075 CHESTNUT ST, NANTY GLO, PA 15943-1209
(814) 749-8799
(814) 749-8799
Mailing address
1075 CHESTNUT ST, NANTY GLO, PA 15943-1209
(814) 749-8799
(814) 749-8799
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
327360
PA
310400000X
Assisted Living Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
327360
LICENSE
PA
Enumeration date
09/29/2021
Last updated
09/29/2021
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