Healthcare Provider Details

I. General information

NPI: 1215325725
Provider Name (Legal Business Name): RICK VAN STORY RESOURCE CENER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 2ND ST
WILMINGTON DE
19801-2312
US

IV. Provider business mailing address

500 W 2ND ST
WILMINGTON DE
19801-2312
US

V. Phone/Fax

Practice location:
  • Phone: 302-691-7946
  • Fax: 302-654-4778
Mailing address:
  • Phone: 302-691-7946
  • Fax: 302-654-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02148
License Number StateDE
# 5
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number02148
License Number StateDE

VIII. Authorized Official

Name: MR. ALLEN CONOVER
Title or Position: C.E.O
Credential:
Phone: 302-530-0342