Healthcare Provider Details

I. General information

NPI: 1356352033
Provider Name (Legal Business Name): DELTACARE HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 TEXAS DR
IRVING TX
75062-7058
US

IV. Provider business mailing address

2608 TEXAS DR
IRVING TX
75062-7058
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-6171
  • Fax: 972-257-3193
Mailing address:
  • Phone: 972-255-6171
  • Fax: 972-257-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009062
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: SOPHIAMMA CHACKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 972-255-6171