Provider Demographics
NPI:1326462920
Name:WILMINGTON ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:WILMINGTON ASSISTED LIVING LLC
Other - Org Name:SUNRISE OF WILMINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUCZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-475-9163
Mailing Address - Street 1:2215 SHIPLEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2305
Mailing Address - Country:US
Mailing Address - Phone:302-475-9163
Mailing Address - Fax:302-475-9164
Practice Address - Street 1:2215 SHIPLEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2305
Practice Address - Country:US
Practice Address - Phone:302-475-9163
Practice Address - Fax:302-475-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1683310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility