Active NPI
State of Delaware
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Dover, DE
National Provider Identifier
1104871920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- STATE OF DELAWARE
- Practice address
- 805 River Rd
Dover, DE 19901-3753 - Phone
- (302) 739-4275
- NPI assigned
- May 23, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Stanley J Kotula
- Title
- Medical Director/Director of Clinic
- Phone
- (302) 576-6093
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary |
Addresses
Primary practice location
805 River Rd
Dover, DE 19901-3753
Mailing address
10 SW Front St
Milford, DE 19963-1948
Phone (302) 422-1422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000609824 | Medicaid | DE |
Other names 1
- Kent/Sussex Community Mental Health Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000575 | DE | Part B Supplier - Clinic/Group Practice | 6507756731 |
Receives reassigned benefits from 7 practitioners 5 other NPIs on this enrollment Practice locations: Dover, DE; Smyrna, DE |
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Wilmington, DE
- NPI 1609895762
O20040319000575
-
- Intellectual Disabilities Intermediate Care Facility
- Georgetown, DE
- NPI 1558417683
O20040319000575
National Provider Directory
National Provider DirectoryLocations
805 River Rd
#M
Dover, DE 19901
Phone (302) 739-4275
805 River Rd
Dover, DE 19901
Phone (302) 739-4275
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Delaware Hospital F/T Chronically Ill | Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (1%) |
Sep 1, 1983 Sep 1, 1983 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Skilled Nursing Facility
- Smyrna, DE
- NPI 1538123583
Adp of the SNF, Indirect Ownership Interest
Practitioners & affiliated clinicians
Practitioners 18
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Primary Care Nurse Practitioner
- Middletown, DE
- NPI 1043027931
DE
-
- Internal Medicine Physician
- Newark, DE
- NPI 1114130069
-
- Internal Medicine Physician
- Baltimore, MD
- NPI 1063424539
-
- Clinical Social Worker
- Dover, DE
- NPI 1720001670
-
- Psychiatry Physician
- Wilmington, DE
- NPI 1881630507
-
- Obstetrics & Gynecology Nurse Practitioner
- Dover, DE
- NPI 1407858509
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1582588800000",
"number": "1104871920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 SW FRONT ST",
"city": "MILFORD",
"state": "DE",
"postal_code": "199631948",
"telephone_number": "302-422-1422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 RIVER RD",
"city": "DOVER",
"state": "DE",
"postal_code": "199013753",
"telephone_number": "302-739-4275"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATE OF DELAWARE",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-23",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A",
"authorized_official_last_name": "KOTULA",
"authorized_official_first_name": "STANLEY",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "MEDICAL DIRECTOR/DIRECTOR OF CLINIC",
"authorized_official_telephone_number": "302-576-6093",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000609824",
"state": "DE"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kent/Sussex Community Mental Health Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kent/Sussex Community Mental Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.