Healthcare Provider Details

I. General information

NPI: 1841680147
Provider Name (Legal Business Name): LA RED HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax:
Mailing address:
  • Phone: 302-855-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberL2-0010741
License Number StateDE

VIII. Authorized Official

Name: KAREN ADRIANA RAMIREZ
Title or Position: LPN
Credential: LPN
Phone: 302-855-1233