Healthcare Provider Details

I. General information

NPI: 1518470624
Provider Name (Legal Business Name): CDIG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 11/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 DANFORTH ST
PHILADELPHIA PA
19152-1802
US

IV. Provider business mailing address

221 W 34TH ST
WILMINGTON DE
19802-2608
US

V. Phone/Fax

Practice location:
  • Phone: 302-307-2446
  • Fax:
Mailing address:
  • Phone: 302-307-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKAL LANARD PAYNE SR.
Title or Position: EVP & CFO
Credential:
Phone: 302-307-2446