810 South Broom Street Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1070 Issued in DE

Legal business name

810 SOUTH BROOM STREET OPERATIONS LLC

Doing business as

Hillside Center

Practice address

810 S Broom St
Wilmington, DE 19805-4245

Phone

(302) 652-1181

Fax

(302) 652-1483

NPI assigned

Dec 4, 2007

Last updated

Apr 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael T Berg

Title

Assistant Secretary

Phone

(505) 468-4742

Specialties & licenses 1

Addresses

Other names 1

• Hillside Center Doing business as

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1982886636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "610-925-4436",
            "fax_number": "610-925-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 S BROOM ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198054245",
            "telephone_number": "302-652-1181",
            "fax_number": "302-652-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "810 SOUTH BROOM STREET OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "DE",
            "license": "1070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hillside Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hillside Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.