Provider Demographics
NPI:1194265728
Name:ASSURANCE HEALTH WILMINGTON, LLC
Entity type:Organization
Organization Name:ASSURANCE HEALTH WILMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-870-1396
Mailing Address - Street 1:8465 KEYSTONE XING
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4355
Mailing Address - Country:US
Mailing Address - Phone:317-870-1396
Mailing Address - Fax:317-757-8491
Practice Address - Street 1:610 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2125
Practice Address - Country:US
Practice Address - Phone:317-870-1396
Practice Address - Fax:317-757-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit