Provider Demographics
NPI:1982973186
Name:DELTA HOME HEALTH INC
Entity Type:Organization
Organization Name:DELTA HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CLINICAL SERVICES / ASST. CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-247-1254
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-0373
Mailing Address - Country:US
Mailing Address - Phone:662-247-1254
Mailing Address - Fax:662-247-4924
Practice Address - Street 1:300-B SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732
Practice Address - Country:US
Practice Address - Phone:662-843-7533
Practice Address - Fax:662-247-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2581251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00070608Medicaid
MS25-7086Medicare PIN