Provider Demographics
NPI:1356629984
Name:NANTICOKE WELLNESS SEAFORD
Entity Type:Organization
Organization Name:NANTICOKE WELLNESS SEAFORD
Other - Org Name:NANTICOKE WELLNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-6611
Mailing Address - Street 1:801 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3636
Mailing Address - Country:US
Mailing Address - Phone:302-846-0303
Mailing Address - Fax:302-846-0502
Practice Address - Street 1:200 N 8TH ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-1374
Practice Address - Country:US
Practice Address - Phone:302-846-0303
Practice Address - Fax:302-846-0502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NANTICOKE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health