Healthcare Provider Details

I. General information

NPI: 1477934669
Provider Name (Legal Business Name): DELTA COMMUNITY SUPPORTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507B WHEATLAND AVE APT A
BOUND BROOK NJ
08805-1819
US

IV. Provider business mailing address

1777 SENTRY PKWY W GWYNEDD HALL, SUITE 400
BLUE BELL PA
19422-2207
US

V. Phone/Fax

Practice location:
  • Phone: 732-302-4567
  • Fax:
Mailing address:
  • Phone: 215-654-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. WYHER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 215-654-1000