Provider Demographics
NPI:1245622190
Name:DEL HOLDINGS, LLC
Entity type:Organization
Organization Name:DEL HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, BCTMB
Authorized Official - Phone:208-557-3516
Mailing Address - Street 1:342 W 1ST S
Mailing Address - Street 2:APT 701
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5132
Mailing Address - Country:US
Mailing Address - Phone:208-557-3516
Mailing Address - Fax:208-549-7575
Practice Address - Street 1:32 CARLSON AVE
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1914
Practice Address - Country:US
Practice Address - Phone:208-557-3516
Practice Address - Fax:208-549-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-1466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty