Provider Demographics
NPI: | 1083699433 |
---|---|
Name: | CHRISTIANA CARE HEALTH SERVICES, INC |
Entity type: | Organization |
Organization Name: | CHRISTIANA CARE HEALTH SERVICES, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | MCMURRAY |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 302-428-2522 |
Mailing Address - Street 1: | PO BOX 30170 |
Mailing Address - Street 2: | |
Mailing Address - City: | WILMINGTON |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19805-7170 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-623-7000 |
Mailing Address - Fax: | 302-623-7374 |
Practice Address - Street 1: | 501 W 14TH ST |
Practice Address - Street 2: | WILMINGTON HOSPITAL |
Practice Address - City: | WILMINGTON |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19801-1013 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-428-2100 |
Practice Address - Fax: | 302-428-2121 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHRISTIANA CARE HEALTH SERVICES INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2005-12-08 |
Last Update Date: | 2022-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YM0800X, 101YP2500X, 103T00000X, 104100000X, 1041C0700X, 106H00000X, 363A00000X, 363LP0808X, 364SP0808X, 364SP0809X, 2084P0800X | ||
DE | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DE | 1083699433 | Medicaid | |
DE | 1083699433 | Medicaid |