Provider Demographics
NPI:1013392968
Name:EASTER SEALS DELAWARE & MARYLAND'S EASTERN SHORE
Entity Type:Organization
Organization Name:EASTER SEALS DELAWARE & MARYLAND'S EASTERN SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-221-2034
Mailing Address - Street 1:1336 BELMONT AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4500
Mailing Address - Country:US
Mailing Address - Phone:410-546-2894
Mailing Address - Fax:
Practice Address - Street 1:1336 BELMONT AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4500
Practice Address - Country:US
Practice Address - Phone:410-546-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8276013 00Medicaid