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General NPI Number Information
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NPI Number | 1275739062
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Entity Type | Organization
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Legal Business Name | DELTA FAMILY HEALTH AND FITNESS CENTER FOR CHILDREN, INC.
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 815 E SAINT LOUIS ST
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City | HAMBURG
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State | AR
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Zip | 71646-2766
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Country | US
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Telephone | 870-853-4224
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Fax | 870-853-9909
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Provider Business Mailing Address
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Address Line | 100 W POLK ST
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City | HAMBURG
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State | AR
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Zip | 71646-3179
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Country | US
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Telephone | 870-853-4224
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Fax | 870-853-9909
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PATRICK LEONARD FIELDS
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Credential |
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Telephone | 870-853-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 20101
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License Number State | AR
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