Provider Demographics
NPI:1356336622
Name:CHANCELLOR CARE CENTER OF DELMAR
Entity type:Organization
Organization Name:CHANCELLOR CARE CENTER OF DELMAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-846-3077
Mailing Address - Street 1:12904 BUCKEYE DR
Mailing Address - Street 2:
Mailing Address - City:DARNESTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3532
Mailing Address - Country:US
Mailing Address - Phone:302-846-3077
Mailing Address - Fax:302-846-3148
Practice Address - Street 1:101 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-1110
Practice Address - Country:US
Practice Address - Phone:302-846-3077
Practice Address - Fax:302-846-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1028314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000429612Medicaid
DE0000430011Medicaid
DE0000430011Medicaid