Provider Demographics
NPI:1538341615
Name:PENINSULA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:PENINSULA HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LITWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-731-2500
Mailing Address - Street 1:26002 JOHN J WILLIAMS HWY
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4948
Mailing Address - Country:US
Mailing Address - Phone:302-947-4200
Mailing Address - Fax:
Practice Address - Street 1:26002 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4948
Practice Address - Country:US
Practice Address - Phone:484-731-2500
Practice Address - Fax:484-731-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1538341615Medicaid
DE085052Medicare Oscar/Certification