Healthcare Provider Details

I. General information

NPI: 1235135732
Provider Name (Legal Business Name): THE MILTON AND HATTIE KUTZ HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 RIVER RD
WILMINGTON DE
19809-2746
US

IV. Provider business mailing address

704 RIVER RD
WILMINGTON DE
19809-2746
US

V. Phone/Fax

Practice location:
  • Phone: 302-764-7000
  • Fax: 302-764-2224
Mailing address:
  • Phone: 302-764-7000
  • Fax: 302-764-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1154
License Number StateDE

VIII. Authorized Official

Name: MR. DAVID D BACHER
Title or Position: CFO
Credential: CPA
Phone: 302-764-7000