Healthcare Provider Details

I. General information

NPI: 1497373864
Provider Name (Legal Business Name): DELANY'S HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MARION AVE
MANSFIELD OH
44903-2015
US

IV. Provider business mailing address

390 MARION AVE
MANSFIELD OH
44903-2015
US

V. Phone/Fax

Practice location:
  • Phone: 419-775-7534
  • Fax: 419-775-7537
Mailing address:
  • Phone: 419-775-7534
  • Fax: 419-775-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI MARIE DELANY
Title or Position: OWNER
Credential: CNP
Phone: 419-775-7534