=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568908655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELTA HOME HEALTH CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2017
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2534 STATE ST #440
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-522-9442
-----------------------------------------------------
Fax | 858-408-4221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2534 STATE ST #440
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-522-9442
-----------------------------------------------------
Fax | 858-408-4221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | JAMES REINKING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-522-9442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------