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NPI Code Detail

MEDICARE: BRANDYWINE CENTER FOR AUTISM, LLC

MEDICARE: BRANDYWINE CENTER FOR AUTISM, LLC
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
1261QM1300XMulti-Specialty Clinic/Center
2251S00000XCommunity/Behavioral Health Agency
3252Y00000XEarly Intervention Provider Agency2014605224DE
4251S00000XCommunity/Behavioral Health Agency2014605224DE

General Provider Information

NPI Number : 1649673427
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRANDYWINE CENTER FOR AUTISM, LLC
Provider Business Mailing Address
First Line : 510 PHILADELPHIA PIKE
Second Line :
City : WILMINGTON
State : DE
Zip : 19809-2100
Country : US
Telephone Number : 302-575-9702
Fax Number : 302-348-9028
Provider Business Practice Location Address
First Line : 510 PHILADELPHIA PIKE
Second Line :
City : WILMINGTON
State : DE
Zip : 19809-2100
Country : US
Telephone Number : 302-575-9702
Fax Number : 302-348-9028
Authorized Official
Title or Position : OWNER
Name : MARCUS HENRY
Credential : CEO
Telephone Number : 302-762-2636
Provider Enumeration Date : 10/07/2014
Last Update Date : 06/07/2024

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