Provider Demographics
NPI:1841303591
Name:AMERICOAST DELAWARE, LLC
Entity type:Organization
Organization Name:AMERICOAST DELAWARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:CUMMISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-568-2236
Mailing Address - Street 1:60 NORTHPOINTE PKWY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1883
Mailing Address - Country:US
Mailing Address - Phone:716-568-2236
Mailing Address - Fax:716-568-2243
Practice Address - Street 1:1 TRADING POST PLAZA
Practice Address - Street 2:SUITE 10
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-9019
Practice Address - Country:US
Practice Address - Phone:302-945-8081
Practice Address - Fax:302-945-8082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE04-34957-21-000332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035403Medicaid
DE5354120001Medicare ID - Type UnspecifiedMEDICARE ID NUMBER