Provider Demographics
NPI:1053857227
Name:VERDE LOMA
Entity Type:Organization
Organization Name:VERDE LOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENZA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FABBER
Authorized Official - Suffix:
Authorized Official - Credentials:LINCESE MH COUNSELOR
Authorized Official - Phone:302-858-4040
Mailing Address - Street 1:401 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2197
Mailing Address - Country:US
Mailing Address - Phone:302-858-4040
Mailing Address - Fax:
Practice Address - Street 1:401 N BEDFORD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2197
Practice Address - Country:US
Practice Address - Phone:302-858-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000437251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health