Provider Demographics
NPI:1689829269
Name:DELTA HEALTHCARE MANAGEMENT
Entity Type:Organization
Organization Name:DELTA HEALTHCARE MANAGEMENT
Other - Org Name:HERITAGE OAKS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-864-3249
Mailing Address - Street 1:916 S MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5405
Mailing Address - Country:US
Mailing Address - Phone:704-864-3249
Mailing Address - Fax:
Practice Address - Street 1:916 S MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5405
Practice Address - Country:US
Practice Address - Phone:704-864-3249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL036027310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility