1528111739 NPI number — AIDS DELAWARE, INC.

Table of content: (NPI 1528111739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528111739 NPI number — AIDS DELAWARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIDS 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:
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:
1528111739
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:
100 W 10TH ST
Provider Second Line Business Mailing Address:
SUITE 315
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-6603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-652-6776
Provider Business Mailing Address Fax Number:
302-652-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 REHOBOTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-1667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-226-5350
Provider Business Practice Location Address Fax Number:
302-226-3519
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
302-652-6776

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  103TH0100N , 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: 0001090357 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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