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General NPI Number Information
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NPI Number | 1770030579
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Entity Type | Organization
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Legal Business Name | BEIT SHALOM/HOUSE OF PEACE
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 130 PLYMOUTH PL
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8313
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Country | US
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Telephone | 678-255-5990
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Fax |
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Provider Business Mailing Address
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Address Line | 130 PLYMOUTH PL
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MILES A RAYNOR
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Credential |
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Telephone | 678-255-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2016606010
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License Number State | DE
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