1124179718 NPI number — CARELINK COMMUNITY SUPPORT SERVICES OF DE, INC

Table of content: (NPI 1124179718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124179718 NPI number — CARELINK COMMUNITY SUPPORT SERVICES OF DE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARELINK COMMUNITY SUPPORT SERVICES OF DE, 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:
Provider Other Organization Name Type Code:
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:
1124179718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
EDDYSTONE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19022-1375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-874-1119
Provider Business Mailing Address Fax Number:
610-872-3407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-429-6693
Provider Business Practice Location Address Fax Number:
302-429-8031
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCADDEN
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
610-874-1119

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 851802 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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