Healthcare Provider Details

I. General information

NPI: 1548347602
Provider Name (Legal Business Name): STATE OF DELAWARE DSCYF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER ST
NEW CASTLE DE
19720-1404
US

IV. Provider business mailing address

10 CENTER ST
NEW CASTLE DE
19720-1404
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-6661
  • Fax:
Mailing address:
  • Phone: 302-421-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number140942
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number140954
License Number StateDE

VIII. Authorized Official

Name: JOSETTE MANNING
Title or Position: CABINET SECRETARY
Credential: ESQ.
Phone: 302-633-2500