Provider Demographics
NPI:1649642075
Name:DELTA VALLEY DEVELOPMENT CORP #2
Entity type:Organization
Organization Name:DELTA VALLEY DEVELOPMENT CORP #2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6662-704-5037
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:ITTA BENA
Mailing Address - State:MS
Mailing Address - Zip Code:38941-0427
Mailing Address - Country:US
Mailing Address - Phone:662-704-5037
Mailing Address - Fax:662-704-5008
Practice Address - Street 1:117 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-0117
Practice Address - Country:US
Practice Address - Phone:662-704-5037
Practice Address - Fax:662-704-5008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care