Provider Demographics
NPI:1558486589
Name:DELTA AMERICAN HELATHCARE, INC
Entity Type:Organization
Organization Name:DELTA AMERICAN HELATHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-878-9058
Mailing Address - Street 1:115 BROADWAY ST
Mailing Address - Street 2:PO BOX 727
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2903
Mailing Address - Country:US
Mailing Address - Phone:318-878-9058
Mailing Address - Fax:318-878-9053
Practice Address - Street 1:119 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2903
Practice Address - Country:US
Practice Address - Phone:318-878-9017
Practice Address - Fax:318-878-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA601315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1718564OtherPROVIDER # BEE BAYOU CH