MEDICARE: DELTA HOUSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1700957883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA HOUSE LLC

Provider Business Mailing Address
First Line	:	2423 LAMB AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-4419
Country	:	US
Telephone Number	:	804-269-0915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 HARVARD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-3522
Country	:	US
Telephone Number	:	804-269-0915
Fax Number	:	804-269-3094

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATERESEA LASHA FORD
Credential	:
Telephone Number	:	804-269-0915

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	08/22/2020

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Directions to “DELTA HOUSE LLC ” Practice Location

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