NPIMap

Organization Active NPI

State of Delaware

Doing business as Kent/Sussex Community Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dover, DE
National Provider Identifier
1104871920
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
STATE OF DELAWARE
Doing business as
Kent/Sussex Community Mental Health Center
Practice address
805 River Rd
Dover, DE 19901-3753
Phone
(302) 739-4275
NPI assigned
May 23, 2006
Last updated
Feb 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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)CodeLicenseStatePrimary
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 names 1

  • Kent/Sussex Community Mental Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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.

National Provider Directory

National Provider Directory

Locations

805 River Rd
Dover, DE 19901
Phone (302) 739-4275

805 River Rd
#M
Dover, DE 19901
Phone (302) 739-4275

10 SW Front St
Milford, DE 19963
Phone (302) 491-4740

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.

FacilityTypeRoleSince
Delaware Hospital F/T Chronically IllSmyrna, DE, CCN 085035 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.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

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": [],
    "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

Verify at the official NPI Registry.