Healthcare Provider Details

I. General information

NPI: 1548453574
Provider Name (Legal Business Name): DELTA CARE , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 N SONORA AVE STE 113
FRESNO CA
93722-3966
US

IV. Provider business mailing address

4705 N SONORA AVE STE 113
FRESNO CA
93722-3966
US

V. Phone/Fax

Practice location:
  • Phone: 559-276-7558
  • Fax: 559-276-7568
Mailing address:
  • Phone: 559-276-7558
  • Fax: 559-276-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA OBIAJULUM ENUNWA
Title or Position: EXECUTIVE DIRECTOR
Credential: , RN, MSN, NP
Phone: 559-289-6785