Healthcare Provider Details

I. General information

NPI: 1275131104
Provider Name (Legal Business Name): AQUILA OF DELAWARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 RED LION RD
BEAR DE
19701-2417
US

IV. Provider business mailing address

4185 KIRKWOOD ST GEORGES RD
BEAR DE
19701-2272
US

V. Phone/Fax

Practice location:
  • Phone: 392-584-5878
  • Fax:
Mailing address:
  • Phone: 302-999-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDI A PATTERSON
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 302-999-1106