Provider Demographics
NPI:1780613950
Name:DELCARE, PA
Entity type:Organization
Organization Name:DELCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-751-7355
Mailing Address - Street 1:1400 US HWY 441 N., SUITE 924
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-1884
Mailing Address - Country:US
Mailing Address - Phone:352-751-7355
Mailing Address - Fax:352-753-3455
Practice Address - Street 1:1400 US HWY 441 N., SUITE 924
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-1884
Practice Address - Country:US
Practice Address - Phone:352-751-7355
Practice Address - Fax:352-753-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260252100Medicaid
FL260252100Medicaid
FLH31837Medicare UPIN