Provider Demographics
NPI:1235294380
Name:INTERIM HEALTHCARE OF DELAWARE LLC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF DELAWARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:302-322-2743
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1477
Mailing Address - Country:US
Mailing Address - Phone:302-322-2743
Mailing Address - Fax:302-328-5086
Practice Address - Street 1:340 N HIGH STREET EXTENDED
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1183
Practice Address - Country:US
Practice Address - Phone:302-322-2743
Practice Address - Fax:302-328-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X
DEHHAS-029A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000054114Medicaid
DE087026Medicare Oscar/Certification