Provider Demographics
NPI:1356352033
Name:DELTACARE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DELTACARE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIAMMA
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-255-6171
Mailing Address - Street 1:2608 TEXAS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-7058
Mailing Address - Country:US
Mailing Address - Phone:972-255-6171
Mailing Address - Fax:972-257-3193
Practice Address - Street 1:2608 TEXAS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7058
Practice Address - Country:US
Practice Address - Phone:972-255-6171
Practice Address - Fax:972-257-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX009062251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453195Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER