| Rlccc | |
|
3135 Summit Bridge Rd Bear DE 19701-2001 | |
| (302) 275-8577 | |
| (302) 454-7274 |
| Full Name | Rlccc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3135 Summit Bridge Rd, Bear, Delaware |
| Authorized Official Name and Position | Grant R Hasty (CEO/DIRECTOR/COUNSELOR) |
| Authorized Official Contact | 3022758577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rlccc 34 Dalton Dr Newark DE 19702-2059 Ph: () - | Rlccc 3135 Summit Bridge Rd Bear DE 19701-2001 Ph: (302) 275-8577 |
| NPI Number | 1972520534 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 05/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972520534 | NPI | - | NPPES |
| 1000035733 | Medicaid | DE | |
| 1000039721 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | Q1-0000765 (Delaware) | Primary |
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