Provider Demographics
NPI:1962956797
Name:IN HOME SERVICES OF CENTRAL PA, LLC
Entity type:Organization
Organization Name:IN HOME SERVICES OF CENTRAL PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-881-2046
Mailing Address - Street 1:20 WINDMILL HL STE 7
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:PA
Mailing Address - Zip Code:17009-1837
Mailing Address - Country:US
Mailing Address - Phone:888-881-2046
Mailing Address - Fax:
Practice Address - Street 1:20 WINDMILL HL STE 7
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1837
Practice Address - Country:US
Practice Address - Phone:888-881-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA27353601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030851110001Medicaid