Basic Information
| Provider Information | |||||||||
| NPI: | 1699288803 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTIANA CARE HEALTH INITIATIVES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CCHI FAMILY PRACTICE NJ | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026237362 | ||||||||
| FaxNumber: | 3026230394 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 EAST AVE STE C | ||||||||
| Address2: | |||||||||
| City: | WOODSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080981351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567692800 | ||||||||
| FaxNumber: | 8567694256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | ABAD | ||||||||
| AuthorizedOfficialFirstName: | AILEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3026237362 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHRISTIANA CARE HEALTH INITIATIVES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.