Provider Demographics
NPI:1306820725
Name:CHRISTIANA CARE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CHRISTIANA CARE HEALTH SERVICES, INC
Other - Org Name:CCHS-ADULT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP FINANCE/MANAGED CARE, CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-623-7203
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:WILMINGTON HOSPITAL
Practice Address - Street 2:501 W. 14TH STREET, 2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19899
Practice Address - Country:US
Practice Address - Phone:302-428-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIANA CARE HEALTH SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-30
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1306820725Medicaid
DE000627002Medicaid
DE553800Medicare PIN