Basic Information
| Provider Information | |||||||||
| NPI: | 1548453574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELTA CARE , INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 N SONORA AVE STE 113 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592767558 | ||||||||
| FaxNumber: | 5592767568 | ||||||||
| Practice Location | |||||||||
| Address1: | 4705 N SONORA AVE STE 113 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592767558 | ||||||||
| FaxNumber: | 5592767568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | ENUNWA | ||||||||
| AuthorizedOfficialFirstName: | RITA | ||||||||
| AuthorizedOfficialMiddleName: | OBIAJULUM | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5592896785 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | , RN, MSN, NP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.