Provider Demographics
NPI: | 1437156635 |
---|---|
Name: | EASTER SEALS DELAWARE & MARYLANDS EASTERN SHORE, INC |
Entity Type: | Organization |
Organization Name: | EASTER SEALS DELAWARE & MARYLANDS EASTERN SHORE, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | PAMELA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | REUTHER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 302-324-4444 |
Mailing Address - Street 1: | 61 CORPORATE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW CASTLE |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19720-2405 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-324-4444 |
Mailing Address - Fax: | 302-324-4441 |
Practice Address - Street 1: | 61 CORPORATE CIR |
Practice Address - Street 2: | |
Practice Address - City: | NEW CASTLE |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19720-2439 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-324-4444 |
Practice Address - Fax: | 302-324-4441 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-01 |
Last Update Date: | 2022-08-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103K00000X, 103TM1800X, 103TR0400X, 224Z00000X, 225200000X, 225X00000X, 235Z00000X, 261QA0600X | ||
DE | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DE | 086517 | Medicare ID - Type Unspecified | MEDICARE PROVIDER NUMBER |