Delta Health Care and Managment Services Corp.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

030000682 Issued in CA

Legal business name

DELTA HEALTH CARE AND MANAGMENT SERVICES CORP.

Practice address

1425 S Center St
Stockton, CA 95206-2016

Phone

(209) 751-3920

Fax

(209) 751-3914

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brent Andrew Williams

Title

Executive Director

Phone

(209) 751-3920

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Delta Health Care Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1407934458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952010550",
            "telephone_number": "209-751-3920",
            "fax_number": "209-751-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S CENTER ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952062016",
            "telephone_number": "209-751-3920",
            "fax_number": "209-751-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA HEALTH CARE AND MANAGMENT SERVICES CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-751-3920",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "030000682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP11503G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70825F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70920F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70817F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR11503G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Health Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinic/Center in Stockton, CA
• Providers in Stockton, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.