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General NPI Number Information
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NPI Number | 1275341133
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Entity Type | Organization
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Legal Business Name | DELTA SOUTH PERSONAL CARE
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 124 ACWIN ST 124 ACWIN ST
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City | GILMORE
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State | AR
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Zip | 72339-0003
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Country | US
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Telephone | 870-702-1820
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Fax | 501-325-0920
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | GILMORE
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State | AR
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Zip | 72339-0003
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Country | US
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Telephone | 870-702-1820
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Fax | 501-325-0920
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | DEBORAH A ELMORE
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Credential |
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Telephone | 870-702-1820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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