Provider Demographics
NPI:1679848204
Name:DELTA SOUL MEDICAL HOMECARE, LLC
Entity Type:Organization
Organization Name:DELTA SOUL MEDICAL HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZEYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-0006
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-0718
Mailing Address - Country:US
Mailing Address - Phone:662-843-0006
Mailing Address - Fax:662-843-0002
Practice Address - Street 1:103 S COURT ST
Practice Address - Street 2:SUITE 118
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2651
Practice Address - Country:US
Practice Address - Phone:662-843-0006
Practice Address - Fax:662-843-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty