Provider Demographics
NPI:1750003380
Name:REHOBOTH WELL
Entity type:Organization
Organization Name:REHOBOTH WELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:TITUS-GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:302-391-4611
Mailing Address - Street 1:528 BERGENIA LOOP
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4883
Mailing Address - Country:US
Mailing Address - Phone:302-391-4611
Mailing Address - Fax:
Practice Address - Street 1:528 BERGENIA LOOP
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4883
Practice Address - Country:US
Practice Address - Phone:302-391-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health