Healthcare Provider Details

I. General information

NPI: 1316947799
Provider Name (Legal Business Name): PENINSULA UNITED METHODIST HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MIDDLEFORD RD
SEAFORD DE
19973-3638
US

IV. Provider business mailing address

726 LOVEVILLE RD
HOCKESSIN DE
19707-1515
US

V. Phone/Fax

Practice location:
  • Phone: 302-235-6066
  • Fax: 302-235-6001
Mailing address:
  • Phone: 302-235-6066
  • Fax: 302-235-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10002546
License Number StateDE

VIII. Authorized Official

Name: MR. WILLIAM L STARCHER JR.
Title or Position: EXEC VP/ CFO
Credential:
Phone: 302-235-6827