Provider Demographics
NPI:1184745564
Name:DELTA HOUSE II
Entity type:Organization
Organization Name:DELTA HOUSE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERESEA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-683-8608
Mailing Address - Street 1:2423 LAMB AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-4419
Mailing Address - Country:US
Mailing Address - Phone:804-683-8608
Mailing Address - Fax:804-228-3443
Practice Address - Street 1:7014 HORESPEN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-4419
Practice Address - Country:US
Practice Address - Phone:804-683-8608
Practice Address - Fax:804-228-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities