Provider Demographics
NPI:1336494616
Name:DELTA COMMUNITY ACTION ASSOCIATION INC
Entity Type:Organization
Organization Name:DELTA COMMUNITY ACTION ASSOCIATION INC
Other - Org Name:DELTA RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-2130
Mailing Address - Street 1:404 E CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-3718
Mailing Address - Country:US
Mailing Address - Phone:318-574-4164
Mailing Address - Fax:318-574-4164
Practice Address - Street 1:404 E CRAIG ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3718
Practice Address - Country:US
Practice Address - Phone:318-574-4164
Practice Address - Fax:318-574-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA179251S00000X
LA179A251S00000X
LA179B251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health