Provider Demographics
NPI:1972058725
Name:DELTA T
Entity type:Organization
Organization Name:DELTA T
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-999-4410
Mailing Address - Street 1:16485 N STADIUM WAY UNIT 3024
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4391
Mailing Address - Country:US
Mailing Address - Phone:623-999-4419
Mailing Address - Fax:
Practice Address - Street 1:7500 N DREAMY DRAW DR
Practice Address - Street 2:SUITE250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4660
Practice Address - Country:US
Practice Address - Phone:602-870-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP9666022251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care