Healthcare Provider Details

I. General information

NPI: 1134692668
Provider Name (Legal Business Name): ST ANTHONY'S COMMUNITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 W 10TH ST
WILMINGTON DE
19805-2709
US

IV. Provider business mailing address

1703 W 10TH ST
WILMINGTON DE
19805-2709
US

V. Phone/Fax

Practice location:
  • Phone: 302-421-3721
  • Fax: 302-421-3725
Mailing address:
  • Phone: 302-421-3721
  • Fax: 302-421-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: ERICA BROWN
Title or Position: PROJECT DIRECTOR
Credential:
Phone: 302-421-3733