Healthcare Provider Details

I. General information

NPI: 1376522359
Provider Name (Legal Business Name): BRANDYWINE HUNDRED FIRE CO. NO. 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 BRANDYWINE BLVD
WILMINGTON DE
19809-2530
US

IV. Provider business mailing address

1006 BRANDYWINE BLVD
WILMINGTON DE
19809-2530
US

V. Phone/Fax

Practice location:
  • Phone: 302-764-4901
  • Fax: 302-764-1267
Mailing address:
  • Phone: 302-764-4901
  • Fax: 302-764-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD THOMAS PERILLO
Title or Position: PRESIDENT
Credential:
Phone: 302-764-4901