Provider Demographics
NPI:1659652980
Name:AMS OF DELAWARE, LLC
Entity Type:Organization
Organization Name:AMS OF DELAWARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-301-3070
Mailing Address - Street 1:20576 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-8062
Mailing Address - Country:US
Mailing Address - Phone:302-227-1320
Mailing Address - Fax:302-227-1327
Practice Address - Street 1:20576 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-8062
Practice Address - Country:US
Practice Address - Phone:302-227-1320
Practice Address - Fax:302-227-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
DEDE10023M276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250537708Medicaid