Healthcare Provider Details

I. General information

NPI: 1801487046
Provider Name (Legal Business Name): A PEACEFUL PLACE INTEGRATED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S BRADFORD ST STE 7
DOVER DE
19904-4153
US

IV. Provider business mailing address

1211 PONDEROSA DR
MAGNOLIA DE
19962
US

V. Phone/Fax

Practice location:
  • Phone: 302-264-9436
  • Fax: 302-264-9702
Mailing address:
  • Phone: 302-222-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERICKA DANIEL
Title or Position: CEO/PROVIDER
Credential: APRN
Phone: 302-264-9436