Provider Demographics
NPI:1669793998
Name:DELAUTER, INC.
Entity type:Organization
Organization Name:DELAUTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:DELAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-522-6533
Mailing Address - Street 1:130 BUFFALO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1159
Mailing Address - Country:US
Mailing Address - Phone:570-522-6533
Mailing Address - Fax:570-522-6534
Practice Address - Street 1:130 BUFFALO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1159
Practice Address - Country:US
Practice Address - Phone:570-522-6533
Practice Address - Fax:570-522-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11693601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101244504-0001Medicaid