Provider Demographics
NPI:1700233079
Name:DELTA COMMUNITY ACTION ASSOCIATION, INC.
Entity Type:Organization
Organization Name:DELTA COMMUNITY ACTION ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IREE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:318-574-4164
Mailing Address - Street 1:411 SPARROW ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-3035
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:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3487251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health