Provider Demographics
NPI:1154451839
Name:CAPTAINS DECK, INC.
Entity type:Organization
Organization Name:CAPTAINS DECK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-995-7011
Mailing Address - Street 1:102 ROBINO CT STE 301
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-2365
Mailing Address - Country:US
Mailing Address - Phone:302-995-7011
Mailing Address - Fax:302-995-6030
Practice Address - Street 1:7807 GOVERNOR PRINTZ BLVD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2624
Practice Address - Country:US
Practice Address - Phone:302-798-3500
Practice Address - Fax:302-798-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2002107729310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility