Provider Demographics
NPI:1770999740
Name:DELTA HEALTHCARE LLC
Entity type:Organization
Organization Name:DELTA HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-639-1102
Mailing Address - Street 1:1145 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1040
Mailing Address - Country:US
Mailing Address - Phone:727-754-9797
Mailing Address - Fax:727-754-9809
Practice Address - Street 1:1145 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1040
Practice Address - Country:US
Practice Address - Phone:727-754-9797
Practice Address - Fax:727-754-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11968663310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility