Provider Demographics
NPI:1689721847
Name:SODAT-DELAWARE, INC.
Entity Type:Organization
Organization Name:SODAT-DELAWARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:302-656-4044
Mailing Address - Street 1:625 N ORANGE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-2296
Mailing Address - Country:US
Mailing Address - Phone:302-656-4044
Mailing Address - Fax:302-656-3439
Practice Address - Street 1:625 N ORANGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2296
Practice Address - Country:US
Practice Address - Phone:302-656-4044
Practice Address - Fax:302-656-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE103TP2701XMedicaid