Provider Demographics
NPI:1639612476
Name:DELTA COMMUNITY ENHANCEMENT PROGRAM
Entity Type:Organization
Organization Name:DELTA COMMUNITY ENHANCEMENT PROGRAM
Other - Org Name:DELTA RECOVERY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, SUBSTANCE ABUSE
Authorized Official - Phone:318-559-3356
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-0088
Mailing Address - Country:US
Mailing Address - Phone:318-559-3356
Mailing Address - Fax:318-559-2044
Practice Address - Street 1:411 SPARROW ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-3035
Practice Address - Country:US
Practice Address - Phone:318-559-3356
Practice Address - Fax:318-559-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health