Provider Demographics
NPI:1972645653
Name:DELMARVA RURAL MINISTRIES, INC.
Entity Type:Organization
Organization Name:DELMARVA RURAL MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOU ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERWENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-678-3652
Mailing Address - Street 1:26 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6922
Mailing Address - Country:US
Mailing Address - Phone:302-678-3652
Mailing Address - Fax:302-678-0545
Practice Address - Street 1:1095 S BRADFORD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4141
Practice Address - Country:US
Practice Address - Phone:302-678-2000
Practice Address - Fax:302-346-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025972Medicaid