Active NPI
Stacy Grant
- Early Intervention Provider Agency
- Philadelphia, PA
National Provider Identifier
1669834362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- License
- OC012558
- Practice address
- 415 S 42ND St
Apt 4
Philadelphia, PA 19104-4094 - Phone
- (570) 977-0646
- NPI assigned
- Mar 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | OC012558 | PA | Primary |
Addresses
Primary practice location
415 S 42ND St
Apt 4
Philadelphia, PA 19104-4094
Mailing address
415 S 42ND St
Apt 4
Philadelphia, PA 19104-4094
Phone (570) 977-0646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OC012558 | PA | MD | Early Intervention Provider Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476662400000",
"number": "1669834362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 S 42ND ST",
"address_2": "APT 4",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044094",
"telephone_number": "570-977-0646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 S 42ND ST",
"address_2": "APT 4",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044094",
"telephone_number": "570-977-0646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-22",
"last_updated": "2016-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": "PA",
"license": "OC012558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.