Healthcare Provider Details

I. General information

NPI: 1811012214
Provider Name (Legal Business Name): DELTA AMERICAN HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BROADWAY ST
DELHI LA
71232-2903
US

IV. Provider business mailing address

115 BROADWAY ST PO BOX 727
DELHI LA
71232-2903
US

V. Phone/Fax

Practice location:
  • Phone: 318-878-9011
  • Fax: 318-878-2585
Mailing address:
  • Phone: 318-878-9058
  • Fax: 318-878-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number3913
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RANDALL JAMES WATTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-878-9058