Provider Demographics
NPI:1063238335
Name:STUPENDOUS HOME CARE LLC
Entity type:Organization
Organization Name:STUPENDOUS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-528-5562
Mailing Address - Street 1:3440 LEHIGH ST # 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7001
Mailing Address - Country:US
Mailing Address - Phone:267-528-5562
Mailing Address - Fax:
Practice Address - Street 1:3440 LEHIGH ST # 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7001
Practice Address - Country:US
Practice Address - Phone:267-528-5562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health