Healthcare Provider Details

I. General information

NPI: 1114088192
Provider Name (Legal Business Name): DELMARVA COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 SHILOH CHURCH HURLOCK RD
HURLOCK MD
21613
US

IV. Provider business mailing address

2450 CAMBRIDGE BELTWAY
CAMBRIDGE MD
21613-3679
US

V. Phone/Fax

Practice location:
  • Phone: 410-943-1106
  • Fax:
Mailing address:
  • Phone: 410-221-1900
  • Fax: 410-221-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number10446
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. SANTO A GRANDE
Title or Position: CEO
Credential:
Phone: 410-221-1900