Provider Demographics
| NPI: | 1083699433 |
|---|---|
| Name: | CHRISTIANA CARE HEALTH SERVICES, INC |
| Entity Type: | Organization |
| Organization Name: | CHRISTIANA CARE HEALTH SERVICES, INC |
| Other - Org Name: | CCHS PSYCHIATRY |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROBERT |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | MCMURRAY |
| Authorized Official - Suffix: | JR |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 302-428-2522 |
| Mailing Address - Street 1: | PO BOX 30170 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WILMINGTON |
| Mailing Address - State: | DE |
| Mailing Address - Zip Code: | 19805-7170 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 302-623-7000 |
| Mailing Address - Fax: | 302-623-7374 |
| Practice Address - Street 1: | 501 W 14TH ST |
| Practice Address - Street 2: | WILMINGTON HOSPITAL |
| Practice Address - City: | WILMINGTON |
| Practice Address - State: | DE |
| Practice Address - Zip Code: | 19801-1013 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 302-428-2100 |
| Practice Address - Fax: | 302-428-2121 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CHRISTIANA CARE HEALTH SERVICES INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2005-12-08 |
| Last Update Date: | 2022-11-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 101YP2500X, 103T00000X, 104100000X, 1041C0700X, 106H00000X, 2084P0800X, 363A00000X, 363LP0808X, 364SP0808X, 364SP0809X | ||
| DE | 103T00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| DE | 1083699433 | Medicaid | |
| DE | 1083699433 | Medicaid |
