Provider Demographics
NPI:1316459837
Name:INGLESIDE HOMES, INC.
Entity type:Organization
Organization Name:INGLESIDE HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CESSNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-575-0250
Mailing Address - Street 1:1005 NORTH FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4550
Mailing Address - Country:US
Mailing Address - Phone:302-575-0250
Mailing Address - Fax:302-575-9955
Practice Address - Street 1:1005 NORTH FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4550
Practice Address - Country:US
Practice Address - Phone:302-575-0250
Practice Address - Fax:302-575-9955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INGLESIDE HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEA000000237Medicaid