Basic Information
| Provider Information | |||||||||
| NPI: | 1770986564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUBURBAN PSYCHIATRIC SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 OMEGA DR | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022833300 | ||||||||
| FaxNumber: | 3022833321 | ||||||||
| Practice Location | |||||||||
| Address1: | 5177 W WOODMILL DR | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198084067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029998426 | ||||||||
| FaxNumber: | 3029998761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | INDERPREET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3029998426 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 2014605649 | DE | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.