Provider Demographics
NPI:1144671512
Name:BERGHOLZ, CATHERINE ANN
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:BERGHOLZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:DE
Mailing Address - Zip Code:19955-0023
Mailing Address - Country:US
Mailing Address - Phone:302-272-6958
Mailing Address - Fax:
Practice Address - Street 1:136 WEST COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:DE
Practice Address - Zip Code:19955-0023
Practice Address - Country:US
Practice Address - Phone:302-272-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20156050823747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant