Provider Demographics
NPI:1043577976
Name:GUAVA HOMECARE, INC
Entity Type:Organization
Organization Name:GUAVA HOMECARE, INC
Other - Org Name:GUAVA CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-399-6389
Mailing Address - Street 1:407 VALLEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9113
Mailing Address - Country:US
Mailing Address - Phone:302-399-6389
Mailing Address - Fax:302-482-4300
Practice Address - Street 1:407 VALLEY BROOK DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9113
Practice Address - Country:US
Practice Address - Phone:302-399-6389
Practice Address - Fax:302-482-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEHHAAO0022251E00000X, 261QM1100X, 305R00000X, 343900000X, 347C00000X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3023996389Medicaid
DE3023996389Medicare Oscar/Certification
DE3023996389Medicare NSC
DE3023996389Medicare PIN