Provider Demographics
NPI:1366620494
Name:DELTA AMERICAN HEALTHCARE, INC
Entity type:Organization
Organization Name:DELTA AMERICAN HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-878-9058
Mailing Address - Street 1:115 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2903
Mailing Address - Country:US
Mailing Address - Phone:318-878-9058
Mailing Address - Fax:318-878-9053
Practice Address - Street 1:115 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2903
Practice Address - Country:US
Practice Address - Phone:318-878-9058
Practice Address - Fax:318-878-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
315P00000X
LA3913385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1717312Medicaid
LA1713457Medicaid
LA1718513Medicaid
LA1170780Medicaid
LA1717690Medicaid
LA1718416Medicaid
LA1718564Medicaid
LA1713171Medicaid
LA1913120Medicaid
LA1540978Medicaid
LA1671851Medicaid
LA1718394Medicaid
LA1718556Medicaid
LA1435520Medicaid
LA1713414Medicaid
LA1718408Medicaid
LA1718530Medicaid
LA1979104Medicaid