| Owner | |
|
5 Cornwall Rd Rehoboth Beach DE 19971-1444 | |
| (302) 470-4088 | |
| Not Available |
| Full Name | Owner |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 Cornwall Rd, Rehoboth Beach, Delaware |
| Authorized Official Name and Position | Janice Hare (OWNER) |
| Authorized Official Contact | 3024704088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Owner 5 Cornwall Rd Rehoboth Beach DE 19971-1444 Ph: (302) 470-4088 | Owner 5 Cornwall Rd Rehoboth Beach DE 19971-1444 Ph: (302) 470-4088 |
| NPI Number | 1003693342 |
|---|---|
| Provider Enumeration Date | 09/11/2023 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Medicare PECOS PAC ID | 5890159487 |
|---|---|
| Medicare Enrollment ID | O20230915000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003693342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Primary |
| Provider Name | Summer Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588375323 PECOS PAC ID: 5496120636 Enrollment ID: I20230331001022 |
| Provider Name | Janice Ann Hare |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144820960 PECOS PAC ID: 6608230297 Enrollment ID: I20230915000279 |
| Provider Name | Muriel Frances Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477389674 PECOS PAC ID: 7911431978 Enrollment ID: I20241113001800 |
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