1669610499 NPI number — CONNECTIONS CSP, INC.

Table of content: (NPI 1669610499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669610499 NPI number — CONNECTIONS CSP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTIONS CSP, 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:
CARDINAL AVENUE GROUP HOME
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:
1669610499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2019
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:
722 CARDINAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAR
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19701-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-221-6860
Provider Business Practice Location Address Fax Number:
302-221-6863
Provider Enumeration Date:
02/02/2009

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: 261QM0801X , with the licence number:  2253 , 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: 2253 . This is a "STATE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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