Provider Demographics
NPI:1629092929
Name:DELTA MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELTA MEMORIAL HOSPITAL
Other - Org Name:DELTA MEMORIAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-382-8267
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-0887
Mailing Address - Country:US
Mailing Address - Phone:870-382-3873
Mailing Address - Fax:
Practice Address - Street 1:1020 HIGHWAY 165 E
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2812
Practice Address - Country:US
Practice Address - Phone:870-382-3873
Practice Address - Fax:870-382-3426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3526251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119062514Medicaid
AR047127Medicare PIN