1538123583 NPI number — STATE OF DELAWARE

Table of content: (NPI 1538123583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538123583 NPI number — STATE OF DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF DELAWARE
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:
DELAWARE HOSPITAL FOR THE CHRONICALLY ILL
Provider Other Organization Name Type Code:
5
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:
1538123583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SUNNYSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19977-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-223-1000
Provider Business Mailing Address Fax Number:
302-233-1501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-223-1000
Provider Business Practice Location Address Fax Number:
302-233-1501
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KERKULA
Authorized Official First Name:
BARNABAS
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSPITAL DIRECTOR
Authorized Official Telephone Number:
302-223-1200

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  1046 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 1046 , 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)

  • Identifier: 0000151355 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000031511 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000031412 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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