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General NPI Number Information
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NPI Number | 1407934458
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Entity Type | Organization
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Legal Business Name | DELTA HEALTH CARE AND MANAGMENT SERVICES CORP.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 1425 S CENTER ST
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City | STOCKTON
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State | CA
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Zip | 95206-2016
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Country | US
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Telephone | 209-751-3920
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Fax | 209-751-3914
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | STOCKTON
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State | CA
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Zip | 95201-0550
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Country | US
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Telephone | 209-751-3920
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Fax | 209-751-3919
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BRENT ANDREW WILLIAMS
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Credential |
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Telephone | 209-751-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 030000682
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License Number State | CA
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