=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063513075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEEBE MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 232 MITCHELL ST UNIT 200
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-5830
-----------------------------------------------------
Fax | 302-934-5835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 232 MITCHELL ST UNIT 200
-----------------------------------------------------
City | MILLSBORO
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19966-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-934-5830
-----------------------------------------------------
Fax | 302-934-5835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP AND CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. RYAN KENNEDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-645-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHAS-002
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------