Provider Demographics
NPI:1730433046
Name:DELOATCH ENTERPRISE INC.
Entity type:Organization
Organization Name:DELOATCH ENTERPRISE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELOATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-498-8199
Mailing Address - Street 1:325 B FIRST COLONIAL ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4665
Mailing Address - Country:US
Mailing Address - Phone:757-498-8199
Mailing Address - Fax:757-437-0626
Practice Address - Street 1:325 B FIRST COLONIAL ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4665
Practice Address - Country:US
Practice Address - Phone:757-498-8199
Practice Address - Fax:757-437-0626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELOATCH ENTERPRISE INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1202007654332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies