Provider Demographics
NPI:1538123583
Name:STATE OF DELAWARE
Entity Type:Organization
Organization Name:STATE OF DELAWARE
Other - Org Name:DELAWARE HOSPITAL FOR THE CHRONICALLY ILL
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSPITAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARNABAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KERKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-223-1200
Mailing Address - Street 1:100 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1752
Mailing Address - Country:US
Mailing Address - Phone:302-223-1000
Mailing Address - Fax:302-233-1501
Practice Address - Street 1:100 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-223-1000
Practice Address - Fax:302-233-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1046313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000151355Medicaid
DE0000031511Medicaid
DE0000031412Medicaid
DE0000031511Medicaid
DE166945Medicare PIN