Healthcare Provider Details

I. General information

NPI: 1407437130
Provider Name (Legal Business Name): COMPLETE CARE AT BRACKENVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SAINT CLAIRE DR
HOCKESSIN DE
19707-8906
US

IV. Provider business mailing address

100 SAINT CLAIRE DR
HOCKESSIN DE
19707-8906
US

V. Phone/Fax

Practice location:
  • Phone: 302-234-5420
  • Fax:
Mailing address:
  • Phone: 302-234-5420
  • 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: SHALOM STEIN
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 732-313-0880