Healthcare Provider Details

I. General information

NPI: 1780968107
Provider Name (Legal Business Name): DELTA REGIONAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 TELFAIR ST
DUBLIN GA
31021-3115
US

IV. Provider business mailing address

1634 TELFAIR ST
DUBLIN GA
31021-3115
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1133
  • Fax:
Mailing address:
  • Phone: 478-272-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNDA S. HEBBELN
Title or Position: CFO
Credential:
Phone: 727-723-3021