Provider Demographics
NPI:1801144779
Name:DELIVERANCE HOUSE INCORPORATED
Entity type:Organization
Organization Name:DELIVERANCE HOUSE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-202-4415
Mailing Address - Street 1:2386 W. COLLEGE AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2494
Mailing Address - Country:US
Mailing Address - Phone:916-202-4415
Mailing Address - Fax:
Practice Address - Street 1:2386 W. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2494
Practice Address - Country:US
Practice Address - Phone:916-202-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization