Basic Information
| Provider Information | |||||||||
| NPI: | 1750657029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIANA CARE HEALTH SERVICES INC | ||||||||
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| OtherOrganizationName: | CCHS GENETICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HYGEIA DR | ||||||||
| Address2: | SUITE 2300 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132049 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 2200 CANCER GENETICS | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234593 | ||||||||
| FaxNumber: | 3026234845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2012 | ||||||||
| LastUpdateDate: | 03/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | CORRIGAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3026237203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHRISTIANA CARE HEALTH SERVICES INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Genetic Counselor, MS |
No ID Information.