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General NPI Number Information
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NPI Number | 1073152518
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Entity Type | Organization
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Legal Business Name | DELTACARE ENTERPRISES
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 01/01/2020
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Provider Practice Location Address
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Address Line | 303 URICK ST
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-4342
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Country | US
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Telephone | 352-551-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 487 EAGLECREST DR
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City | HAINES CITY
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State | FL
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Zip | 33844-7757
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Country | US
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Telephone | 352-409-4255
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SETH J GUNN
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Credential |
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Telephone | 352-409-4255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State |
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