Provider Demographics
NPI:1093412983
Name:GERIZIM PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:GERIZIM PSYCHIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMBI-NDIFOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:302-981-2529
Mailing Address - Street 1:729 ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-5801
Mailing Address - Country:US
Mailing Address - Phone:302-981-2529
Mailing Address - Fax:
Practice Address - Street 1:729 ELLEN DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-5801
Practice Address - Country:US
Practice Address - Phone:302-981-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)