Provider Demographics
NPI:1003990425
Name:THE LORELTON FOUNDATION
Entity Type:Organization
Organization Name:THE LORELTON FOUNDATION
Other - Org Name:THE LORELTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:302-573-3580
Mailing Address - Street 1:2200 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3362
Mailing Address - Country:US
Mailing Address - Phone:302-573-3580
Mailing Address - Fax:302-573-3590
Practice Address - Street 1:2200 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3362
Practice Address - Country:US
Practice Address - Phone:302-573-3580
Practice Address - Fax:302-573-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1123310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040656Medicaid