NPIMap

Organization Active NPI

State of de

Doing business as NC Community Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wilmington, DE
National Provider Identifier
1609895762
Registry record updated Dec 31, 2008
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 DE
Doing business as
NC Community Mental Health Center
Practice address
809 N Washington St
Wilmington, DE 19801-1509
Phone
(302) 577-6490
NPI assigned
Jul 19, 2006
Last updated
Dec 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2008

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 Clinci
Phone
(302) 576-6093

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

809 N Washington St
Wilmington, DE 19801-1509

Mailing address

10 SW Front St
Milford, DE 19963-1948
Phone (302) 422-1422

Other identifiers 1

IdentifierTypeStateIssuer
609724MedicaidDE

Other names 1

  • NC 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
This NPI is an additional NPI on the enrollment
Practice locations: Dover, DE; Smyrna, DE

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
Rm 303
Dover, DE 19901

10 SW Front St
Ste 201
Milford, DE 19963

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230681600000",
    "number": "1609895762",
    "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",
            "fax_number": "302-422-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 N WASHINGTON ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011509",
            "telephone_number": "302-577-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF DE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-12-31",
        "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 CLINCI",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609724",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NC Community Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.