=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023665874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE AT HOME OF DELAWARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2019
-----------------------------------------------------
Last Update Date | 08/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 MONTCHANIN RD STE 50
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19807-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-502-7138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 MONTCHANIN RD STE 50
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19807-2179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-502-7138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MORRIS PETERZELL
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 302-442-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------