Healthcare Provider Details

I. General information

NPI: 1336539717
Provider Name (Legal Business Name): 101 E DELAWARE AVE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DELAWARE AVE
DELMAR DE
19940-1110
US

IV. Provider business mailing address

600 BROADWAY
LYNBROOK NY
11563-3980
US

V. Phone/Fax

Practice location:
  • Phone: 302-846-3077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LOUIS GELLIS
Title or Position: MANAGER
Credential:
Phone: 917-533-7241