=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740318872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIANA CARE HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 642 COUNTRY PATH DR
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-7664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-733-6339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 642 COUNTRY PATH DR
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-7664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. SHAHRUKH ALI MIRZA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-733-6339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------