Provider Demographics
NPI:1699165407
Name:SEASCAPE HEALTH ALLIANCE
Entity type:Organization
Organization Name:SEASCAPE HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-807-7983
Mailing Address - Street 1:1031 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5511
Mailing Address - Country:US
Mailing Address - Phone:302-492-6085
Mailing Address - Fax:302-422-9408
Practice Address - Street 1:1031 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5511
Practice Address - Country:US
Practice Address - Phone:302-492-6085
Practice Address - Fax:302-422-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2014606682251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health