Provider Demographics
NPI:1649815887
Name:DTAC OF DELAWARE LLC
Entity type:Organization
Organization Name:DTAC OF DELAWARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:REICHENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:570-524-9986
Mailing Address - Street 1:1950 RUTGERS UNIVERSITY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 E LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-8306
Practice Address - Country:US
Practice Address - Phone:302-734-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health