Provider Demographics
NPI:1609923408
Name:MODERN MATURITY CENTER
Entity Type:Organization
Organization Name:MODERN MATURITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-734-1200
Mailing Address - Street 1:1121 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3308
Mailing Address - Country:US
Mailing Address - Phone:302-734-1200
Mailing Address - Fax:302-674-1265
Practice Address - Street 1:1125 FORREST AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-734-1200
Practice Address - Fax:302-346-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEADC-001251J00000X
251J00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251J00000XAgenciesNursing Care