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General NPI Number Information
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NPI Number | 1174939243
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Entity Type | Organization
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Legal Business Name | DELTA HEALTHCARE II LLC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 4175 E BAY DR
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City | CLEARWATER
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State | FL
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Zip | 33764-6985
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Country | US
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Telephone | 727-330-7898
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Fax | 727-330-7893
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Provider Business Mailing Address
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Address Line | 4175 E BAY DR
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City | CLEARWATER
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State | FL
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Zip | 33764-6985
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Country | US
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Telephone | 727-330-7898
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Fax | 727-330-7893
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | KERRY BINGAMAN
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Credential |
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Telephone | 727-639-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL2518
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License Number State | FL
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