1679704274 NPI number — LIESKE E2E HOME HEALTH CARE INC

Table of content: (NPI 1679704274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679704274 NPI number — LIESKE E2E HOME HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIESKE E2E HOME HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHORECARE OF DELAWARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679704274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 MEADOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-898-1563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-898-1563
Provider Business Practice Location Address Fax Number:
888-330-8395
Provider Enumeration Date:
07/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIESKE
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-898-1563

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2009602420 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)