Provider Demographics
NPI:1992196356
Name:AEGLE HEALTH
Entity Type:Organization
Organization Name:AEGLE HEALTH
Other - Org Name:AEGLE HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:DAMION
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-468-0235
Mailing Address - Street 1:3301 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2052
Mailing Address - Country:US
Mailing Address - Phone:302-468-0235
Mailing Address - Fax:
Practice Address - Street 1:27 CHELWYNNE RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3535
Practice Address - Country:US
Practice Address - Phone:302-468-0235
Practice Address - Fax:302-439-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health