1508225905 NPI number — CONNECTIONS CSP BRANDYWINE STREET WOMEN'S RESIDENTIAL TREATMENT PROGRA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508225905 NPI number — CONNECTIONS CSP BRANDYWINE STREET WOMEN'S RESIDENTIAL TREATMENT PROGRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTIONS CSP BRANDYWINE STREET WOMEN'S RESIDENTIAL TREATMENT PROGRA
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:
CONNECTIONS BRANDYWINE STREET WOMEN'S RESIDENTIAL TREATMENT PROGRAM
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:
1508225905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3821 LANCASTER PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19805-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-442-6622
Provider Business Mailing Address Fax Number:
302-984-3385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 BRANDYWINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19802-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-250-5883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DEVANEY MCKAY
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
302-230-9103

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , 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)





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