Provider Demographics
NPI:1699039982
Name:DELOMATT HOME CARE SERVICES
Entity Type:Organization
Organization Name:DELOMATT HOME CARE SERVICES
Other - Org Name:DELOMATT HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-506-8958
Mailing Address - Street 1:1563 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3051
Mailing Address - Country:US
Mailing Address - Phone:601-506-8958
Mailing Address - Fax:
Practice Address - Street 1:1563 W NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3051
Practice Address - Country:US
Practice Address - Phone:601-506-8958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care