Provider Demographics
NPI:1780922732
Name:KINGSTREE GROUP INC
Entity type:Organization
Organization Name:KINGSTREE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE CASE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:888-853-6412
Mailing Address - Street 1:405 HOLSTEIN CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-6811
Mailing Address - Country:US
Mailing Address - Phone:888-898-3857
Mailing Address - Fax:888-898-3857
Practice Address - Street 1:900 W VALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1852
Practice Address - Country:US
Practice Address - Phone:888-853-6412
Practice Address - Fax:888-898-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10030304302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEL10030304OtherDELAWARE NURSING LICENSE