Basic Information
| Provider Information | |||||||||
| NPI: | 1356482970 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STATE OF DELAWARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | DELAWARE PSYCHIATRIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 N DUPONT HWY | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1901 N DUPONT HWY | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197201160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022552700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ASHBAUGH | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | HOSPITAL ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3022552768 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | HSPTL-009 | DE | X | Hospitals | Psychiatric Hospital | 310500000X | HSPTL-009 | DE | X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 0000121964 | 05 | DE | MEDICAID | 0000151425 | 05 | DE | MEDICAID | HSPTL-009 | 01 | DE | HOSPITAL LICENSE | OTHER |