Provider Demographics
NPI:1598853509
Name:DELTA AREA HOSPICE CARE LIMITED
Entity Type:Organization
Organization Name:DELTA AREA HOSPICE CARE LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-335-7040
Mailing Address - Street 1:PO BOX 5915
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-5915
Mailing Address - Country:US
Mailing Address - Phone:662-335-7040
Mailing Address - Fax:662-335-7027
Practice Address - Street 1:522 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5319
Practice Address - Country:US
Practice Address - Phone:662-335-7040
Practice Address - Fax:662-335-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS012251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770012Medicaid
MS251514OtherMEDICARE HOSPICE