Provider Demographics
NPI:1811012214
Name:DELTA AMERICAN HEALTHCARE, INC
Entity Type:Organization
Organization Name:DELTA AMERICAN HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-878-9058
Mailing Address - Street 1:115 BROADWAY ST
Mailing Address - Street 2:PO BOX 727
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2903
Mailing Address - Country:US
Mailing Address - Phone:318-878-9058
Mailing Address - Fax:318-878-9053
Practice Address - Street 1:119 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2903
Practice Address - Country:US
Practice Address - Phone:318-878-9011
Practice Address - Fax:318-878-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
LA3913385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170780OtherPROVIDER # SIL PCS 24