Provider Demographics
NPI:1508464819
Name:AQUILA OF DELAWARE, INC.
Entity Type:Organization
Organization Name:AQUILA OF DELAWARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DISABATINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-218-0630
Mailing Address - Street 1:850 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4113
Mailing Address - Country:US
Mailing Address - Phone:302-664-7664
Mailing Address - Fax:
Practice Address - Street 1:1539 BOHEMIA MILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-6001
Practice Address - Country:US
Practice Address - Phone:302-378-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder