NPIMap

Organization Active NPI

Delta Memorial Hospital

Doing business as Delta Memorial Home Health

  • Home Health Agency
  • Dumas, AR
National Provider Identifier
1629092929
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
AR3526 Issued in AR
Legal business name
DELTA MEMORIAL HOSPITAL
Doing business as
Delta Memorial Home Health
Practice address
1020 Highway 165 E
Dumas, AR 71639-2812
Phone
(870) 382-3873
Fax
(870) 382-3426
NPI assigned
Jul 27, 2006
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DELTA MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Vicki J Allen
Title
Cfo
Phone
(870) 382-8267

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X AR3526 AR Primary

Addresses

Primary practice location

1020 Highway 165 E
Dumas, AR 71639-2812

Mailing address

PO Box 887
Dumas, AR 71639-0887
Phone (870) 382-3873

Other identifiers 1

IdentifierTypeStateIssuer
119062514MedicaidAR

Other names 1

  • Delta Memorial Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071212000314 AR Part A Provider - Home Health Agency 1658262241 Practice locations: Dumas, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629092929. Details of each certification follow.

Home health agency certification: CCN 047127

Legal name
DELTA MEMORIAL HOSPITAL
Doing business as
DELTA MEMORIAL HOSPITAL HOME HEALTH AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 8, 1991
Last certification
Oct 17, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 1975 in AR
Enrollment address
803 Highway 65 S
Dumas, AR 71639-3006

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Delta Memorial Hospital HHACCN 047127 · All quality measures
Overall star rating
2.5 of 5
Ownership
Non-Profit
Certified
Apr 8, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

National Provider Directory

National Provider Directory
Tax ID family
Delta Memorial Hospital9 organizations share this tax ID, including this one
Part of
Delta Memorial Hospital

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1020 Highway 165 E
Dumas, AR 71639
Phone (870) 382-3873

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Glenn Crow Individual Corporate Director Jul 15, 2010
Alan H Moncrief Individual Corporate DirectorBoard Member Dec 11, 2012
John F Freeman Individual Corporate DirectorBoard Member Jun 27, 2013
Claudine Racy Individual Corporate Director Nov 27, 2007
Robin Shea Individual Other Jul 28, 2012
Vicki Allen Individual Corporate OfficerCfo Apr 4, 2016
Corporate DirectorCfo Apr 4, 2016
W-2 Managing EmployeeCfo Apr 4, 2016
Leah Ann Osbahr Individual Corporate OfficerCeo Apr 12, 2021
Corporate DirectorCeo Apr 12, 2021
W-2 Managing EmployeeCeo Apr 12, 2021
Timothy Jones Individual Corporate Director Jun 25, 2009
Flora Simon Individual Corporate DirectorBoard Member Jun 27, 2013
Shirley Teeter Individual Corporate DirectorBoard Member Dec 11, 2012
Ashley N Anthony Individual Corporate OfficerCeo Oct 1, 2016 100%
Corporate DirectorCeo Oct 1, 2016 100%

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1629092929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "DUMAS",
            "state": "AR",
            "postal_code": "716390887",
            "telephone_number": "870-382-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 HIGHWAY 165 E",
            "city": "DUMAS",
            "state": "AR",
            "postal_code": "716392812",
            "telephone_number": "870-382-3873",
            "fax_number": "870-382-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DELTA MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-27",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-382-8267"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "AR3526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119062514",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delta Memorial Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Delta Memorial Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dumas, AR

Sources for this page

Verify at the official NPI Registry.