MEDICARE: CHRISTIANA CARE HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306820725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIANA CARE HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 30170
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-7170
Country	:	US
Telephone Number	:	302-623-7000
Fax Number	:	302-623-7374

Provider Business Practice Location Address
First Line	:	WILMINGTON HOSPITAL
Second Line	:	501 W. 14TH STREET, 2ND FLOOR
City	:	WILMINGTON
State	:	DE
Zip	:	19899
Country	:	US
Telephone Number	:	302-428-4411
Fax Number	:

Authorized Official
Title or Position	:	SR. VP FINANCE/MANAGED CARE, CFO
Name	:	RICHARD B ELLIS
Credential	:
Telephone Number	:	302-623-7203

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/21/2008

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