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General NPI Number Information
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NPI Number | 1215463203
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Entity Type | Organization
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Legal Business Name | DELTA CARE HOPE FOUNDATION
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 408 HIGHWAY 82 W
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City | INDIANOLA
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State | MS
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Zip | 38751-2031
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Country | US
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Telephone | 662-445-2603
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Fax |
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Provider Business Mailing Address
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Address Line | 408 HIGHWAY 82 W
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City | INDIANOLA
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State | MS
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Zip | 38751-2031
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Country | US
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Telephone | 662-445-2603
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER/ADMINSTRATOR
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Name | MRS. BRENDA A LYNN
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Credential | LMSW
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Telephone | 662-299-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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