=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215238084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANWOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2010
-----------------------------------------------------
Last Update Date | 11/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3407 LANCASTER PIKE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19805-5543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-998-9088
-----------------------------------------------------
Fax | 302-998-9020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3407 LANCASTER PIKE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19805-5543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-998-9088
-----------------------------------------------------
Fax | 302-998-9020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MISS MARCE YOLANDA GARBETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-506-5936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------