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General NPI Number Information
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NPI Number | 1437523511
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Entity Type | Organization
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Legal Business Name | DELTA PEDIATRIC CARE
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 526 FAIRVIEW AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-5401
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Country | US
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Telephone | 662-580-5074
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Fax | 662-580-5074
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Provider Business Mailing Address
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Address Line | PO BOX 2994
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City | MONROE
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State | LA
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Zip | 71207-2994
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Country | US
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Telephone | 662-580-5074
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Fax | 662-580-5074
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Authorized Official
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Title or Position | OWNER
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Name | MAUREEN GALLAGHER
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Credential | MED
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Telephone | 318-512-9218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State | MS
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