| NPI |
1437156635 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Entity Type Code |
2 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Employer Identification Number EIN |
|
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Organization Name Legal Business Name |
EASTER SEALS DELAWARE & MARYLANDS EASTERN SHORE, INC |
The city name in the location address of the provider being identified. |
| Provider First Line Business Practice Location Address |
61 CORPORATE CIR |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name |
NEW CASTLE |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
DE |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
197202439 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address Telephone Number |
3023244444 |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address Fax Number |
3023244441 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Enumeration Date |
7/1/2005 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
8/30/2022 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
REUTHER |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
PAMELA |
The first name of the authorized official. |
| Authorized Official Title or Position |
COO |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
3023244444 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Taxonomy Code 1 |
103K00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Taxonomy Code 2 |
103TR0400X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
| Healthcare Provider Taxonomy Code 3 |
224Z00000X |
|
| Healthcare Provider Primary Taxonomy Switch 3 |
N |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Healthcare Provider Taxonomy Code 4 |
225100000X |
|
| Provider License Number State Code 4 |
DE |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 4 |
N |
|
| Healthcare Provider Taxonomy Code 5 |
225200000X |
|
| Healthcare Provider Primary Taxonomy Switch 5 |
N |
|
| Healthcare Provider Taxonomy Code 6 |
225X00000X |
|
| Healthcare Provider Primary Taxonomy Switch 6 |
N |
|
| Healthcare Provider Taxonomy Code 7 |
235Z00000X |
|
| Healthcare Provider Primary Taxonomy Switch 7 |
N |
|
| Healthcare Provider Taxonomy Code 8 |
261QA0600X |
|
| Healthcare Provider Primary Taxonomy Switch 8 |
N |
|
| Healthcare Provider Taxonomy Code 9 |
103TM1800X |
|
| Healthcare Provider Primary Taxonomy Switch 9 |
Y |
|
| Is Organization Subpart |
N |
|
| Authorized Official Name Prefix Text |
MRS. |
|
| Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 3 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 4 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 5 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 6 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 7 |
193200000X MULTI-SPECIALTY GROUP |
|
| Healthcare Provider Taxonomy Group 9 |
193200000X MULTI-SPECIALTY GROUP |
|
| NPI Certification Date |
8/30/2022 |
|