Provider Demographics
NPI:1982481511
Name:DELTA HOME CARE LLC
Entity type:Organization
Organization Name:DELTA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:MOHD DZAIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHD DAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-353-2368
Mailing Address - Street 1:1923 BEACON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6125
Mailing Address - Country:US
Mailing Address - Phone:479-222-5087
Mailing Address - Fax:949-561-4703
Practice Address - Street 1:1923 BEACON RIDGE WAY
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6125
Practice Address - Country:US
Practice Address - Phone:479-222-5087
Practice Address - Fax:949-561-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care