Healthcare Provider Details

I. General information

NPI: 1306820725
Provider Name (Legal Business Name): CHRISTIANA CARE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILMINGTON HOSPITAL 501 W. 14TH STREET, 2ND FLOOR
WILMINGTON DE
19899
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-4411
  • Fax:
Mailing address:
  • Phone: 302-623-7000
  • Fax: 302-623-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD B ELLIS
Title or Position: SR. VP FINANCE/MANAGED CARE, CFO
Credential:
Phone: 302-623-7203