Stephen Rodrigues, PRESIDENT/CEO

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

327360 Issued in PA

Practice address

1075 Chestnut St
Nanty Glo, PA 15943-1209

Phone

(814) 749-8799

Fax

(814) 749-8799

NPI assigned

Sep 29, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1184396137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 CHESTNUT ST",
            "city": "NANTY GLO",
            "state": "PA",
            "postal_code": "159431209",
            "telephone_number": "814-749-8799",
            "fax_number": "814-749-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 CHESTNUT ST",
            "city": "NANTY GLO",
            "state": "PA",
            "postal_code": "159431209",
            "telephone_number": "814-749-8799",
            "fax_number": "814-749-8799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUES",
        "first_name": "STEPHEN",
        "credential": "PRESIDENT/CEO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "PA",
            "license": "327360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "327360",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH PA",
            "identifier": "327360",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Nanty Glo, PA
• Providers in Nanty Glo, PA by specialty
• Assisted Living Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.