Healthcare Provider Details

I. General information

NPI: 1831956176
Provider Name (Legal Business Name): AUGUSTINE PLACE MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 AUGUSTINE PL
BEAR DE
19701-1007
US

IV. Provider business mailing address

100 MCMULLEN AVE UNIT 1022
NEW CASTLE DE
19720-8038
US

V. Phone/Fax

Practice location:
  • Phone: 267-357-9124
  • Fax: 888-398-5774
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANISHA WILSON
Title or Position: DIRECTOR
Credential:
Phone: 267-357-9124