Provider Demographics
NPI:1144315706
Name:DELCORP HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DELCORP HOME HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:806-231-3239
Mailing Address - Street 1:1408 S. JEFFERESON STREET
Mailing Address - Street 2:SUITE 114
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4048
Mailing Address - Country:US
Mailing Address - Phone:806-373-8100
Mailing Address - Fax:806-378-9996
Practice Address - Street 1:1408 S. JEFFERESON STREET
Practice Address - Street 2:SUITE 114
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4048
Practice Address - Country:US
Practice Address - Phone:806-373-8100
Practice Address - Fax:806-378-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-9534Medicare ID - Type UnspecifiedHOME HEALTH