Provider Demographics
NPI:1407830748
Name:CHRISTIANA CARE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHRISTIANA CARE HEALTH SERVICES INC
Other - Org Name:CCHS DIABETES & METABOLIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:302-428-2522
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:302-623-7019
Mailing Address - Fax:302-623-7009
Practice Address - Street 1:3506 KENNETT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-3019
Practice Address - Country:US
Practice Address - Phone:302-661-3070
Practice Address - Fax:302-066-1308
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:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1407830748Medicaid
DE1407830748Medicaid