1700266046 NPI number — DELTA COMMUNITY SUPPORTS, INC.

Table of content: (NPI 1700266046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700266046 NPI number — DELTA COMMUNITY SUPPORTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA COMMUNITY SUPPORTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700266046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1777 SENTRY PKWY W
Provider Second Line Business Mailing Address:
GWYNEDD HALL, SUITE 400
Provider Business Mailing Address City Name:
BLUE BELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19422-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-654-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 CHERRYVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08822-4950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-788-5048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WYHER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
215-654-1000

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)