Provider Demographics
NPI:1518438464
Name:DELTA EXCELLENCE HEALTH CARE LLC
Entity Type:Organization
Organization Name:DELTA EXCELLENCE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:856-693-2209
Mailing Address - Street 1:6010 FRONTENAC ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3237
Mailing Address - Country:US
Mailing Address - Phone:856-693-2209
Mailing Address - Fax:
Practice Address - Street 1:6010 FRONTENAC ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-3237
Practice Address - Country:US
Practice Address - Phone:856-693-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS44367030053742Medicaid