Provider Demographics
NPI:1982762092
Name:PENINSULA HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:PENINSULA HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:OBIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-629-5672
Mailing Address - Street 1:514 W STEIN HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1202
Mailing Address - Country:US
Mailing Address - Phone:302-629-5672
Mailing Address - Fax:302-628-1587
Practice Address - Street 1:514 W STEIN HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1202
Practice Address - Country:US
Practice Address - Phone:302-629-5672
Practice Address - Fax:302-628-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1995113780332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000650916Medicaid
DE0000650916Medicaid