Provider Demographics
NPI:1780733170
Name:AQUILA OF DELAWARE, INC.
Entity type:Organization
Organization Name:AQUILA OF DELAWARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-293-6741
Mailing Address - Street 1:4185 KIRKWOOD ST GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2272
Mailing Address - Country:US
Mailing Address - Phone:302-270-8577
Mailing Address - Fax:302-838-2326
Practice Address - Street 1:4185 KIRKWOOD ST GEORGES RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2272
Practice Address - Country:US
Practice Address - Phone:302-270-8577
Practice Address - Fax:302-832-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE37761OtherCIGNA
DE159139OtherBLUE CROSS BLUE SHIELD DE
DE174428OtherCOMPSYCH
DE0602528OtherAETNA
DEA066181OtherVALUE OPTIONS