1780733170 NPI number — AQUILA OF DELAWARE, INC.

Table of content: (NPI 1780733170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780733170 NPI number — AQUILA OF DELAWARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AQUILA OF DELAWARE, 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:
AQUILA OF DELAWARE, INC
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:
1780733170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4185 KIRKWOOD ST GEORGES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAR
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19701-2272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-270-8577
Provider Business Mailing Address Fax Number:
302-838-2326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4185 KIRKWOOD ST GEORGES RD
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:
19701-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-270-8577
Provider Business Practice Location Address Fax Number:
302-832-2729
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
302-293-6741

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37761 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 159139 . This is a "BLUE CROSS BLUE SHIELD DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 174428 . This is a "COMPSYCH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0602528 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: A066181 . This is a "VALUE OPTIONS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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