Healthcare Provider Details

I. General information

NPI: 1215463203
Provider Name (Legal Business Name): DELTA CARE HOPE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 HIGHWAY 82 W
INDIANOLA MS
38751-2031
US

IV. Provider business mailing address

408 HIGHWAY 82 W
INDIANOLA MS
38751-2031
US

V. Phone/Fax

Practice location:
  • Phone: 662-445-2603
  • Fax:
Mailing address:
  • Phone: 662-445-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA A LYNN
Title or Position: SOCIAL WORKER/ADMINSTRATOR
Credential: LMSW
Phone: 662-299-9616