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General NPI Number Information
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NPI Number | 1366620494
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Entity Type | Organization
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Legal Business Name | DELTA AMERICAN HEALTHCARE, INC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 115 BROADWAY ST
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City | DELHI
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State | LA
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Zip | 71232-2903
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Country | US
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Telephone | 318-878-9058
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Fax | 318-878-9053
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Provider Business Mailing Address
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Address Line | 115 BROADWAY ST
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City | DELHI
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State | LA
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Zip | 71232-2903
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Country | US
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Telephone | 318-878-9058
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Fax | 318-878-9053
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MR. JESSE PRISOCK
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Credential |
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Telephone | 318-878-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 3913
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License Number State | LA
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