Healthcare Provider Details

I. General information

NPI: 1801721006
Provider Name (Legal Business Name): DELAWARE DEPARTMENT OF CORRECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MCKEE RD
DOVER DE
19904-2232
US

IV. Provider business mailing address

245 MCKEE RD
DOVER DE
19904-2232
US

V. Phone/Fax

Practice location:
  • Phone: 302-857-5263
  • Fax:
Mailing address:
  • Phone: 302-857-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLIN CONSTANCE HOLLAND LYON
Title or Position: CONTROLLER
Credential:
Phone: 302-857-5263