Provider Demographics
NPI:1164563797
Name:INGLESIDE HOMES, INC
Entity Type:Organization
Organization Name:INGLESIDE HOMES, INC
Other - Org Name:INGLESIDE ASSISTED LIVING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-575-0283
Mailing Address - Street 1:1010 N BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4514
Mailing Address - Country:US
Mailing Address - Phone:302-575-0283
Mailing Address - Fax:302-575-9955
Practice Address - Street 1:1605 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3009
Practice Address - Country:US
Practice Address - Phone:302-984-0950
Practice Address - Fax:302-984-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2031310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041286Medicaid