1508213307 NPI number — SALFI'S OLD-FASHIONED PSYCHIATRY, LLC

Table of content: MICHELLE L. REASE GRNA (NPI 1710260344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508213307 NPI number — SALFI'S OLD-FASHIONED PSYCHIATRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALFI'S OLD-FASHIONED PSYCHIATRY, LLC
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:
1508213307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 LAKESIDE DR
Provider Second Line Business Mailing Address:
ATTENTION: SALVATORE SALFI
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-8993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-354-3543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 LAKESIDE DR
Provider Second Line Business Practice Location Address:
ATTENTION: SALVATORE SALFI
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-8993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-354-3543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SALFI
Authorized Official First Name:
SALVATORE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADVANCED PRACTICE REGISTERED NURSE
Authorized Official Telephone Number:
302-354-3543

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  L8-0000123 , 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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