Provider Demographics
NPI:1871793125
Name:STUEBGEN LLC
Entity type:Organization
Organization Name:STUEBGEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:724-360-0099
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056-0277
Mailing Address - Country:US
Mailing Address - Phone:724-360-0099
Mailing Address - Fax:724-360-0098
Practice Address - Street 1:230 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056
Practice Address - Country:US
Practice Address - Phone:724-360-0099
Practice Address - Fax:724-360-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019354670001Medicaid