| David Stackhouse Inc | |
|
101 Main St Sparta NJ 07871-1930 | |
| (973) 886-9701 | |
| (973) 729-4611 |
| Full Name | David Stackhouse Inc |
|---|---|
| Speciality | Social Worker |
| Location | 101 Main St, Sparta, New Jersey |
| Authorized Official Name and Position | David Ray Stackhouse (PRESIDENT) |
| Authorized Official Contact | 9738869701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David Stackhouse Inc Po Box 481 Sparta NJ 07871-0481 Ph: (973) 886-9701 | David Stackhouse Inc 101 Main St Sparta NJ 07871-1930 Ph: (973) 886-9701 |
| NPI Number | 1467736728 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 10/17/2011 |
| Medicare PECOS PAC ID | 4385801588 |
|---|---|
| Medicare Enrollment ID | O20120131000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467736728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC00844700 (New Jersey) | Primary |
| Provider Name | David R Stackhouse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619038502 PECOS PAC ID: 6901846419 Enrollment ID: I20050504000485 |
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