Basic Information
| Provider Information | |||||||||
| NPI: | 1366874828 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTIANA CARE HEALTH SERVICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CCHS CONCORD - THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR | ||||||||
| Address2: | SUITE 2300 - PHYSICIAN CONTRACTING | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 161 WILMINGTON W CHESTER PIKE | ||||||||
| Address2: | CONCORD HEALTH CENTER | ||||||||
| City: | CHADDS FORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193179041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103611195 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCMURRAY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3024282522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHRISTIANA CARE HEALTH SERVICES INC | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QR0200X | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QX0100X | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261Q00000X | PA | N | Ambulatory Health Care Facilities | Clinic/Center | 261QH0700X | PA | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QM1300X | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.