Provider Demographics
NPI:1356449631
Name:DELTA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELTA COUNTY MEMORIAL HOSPITAL
Other - Org Name:DELTA HEALTH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-2256
Mailing Address - Street 1:PO BOX 10100
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-0008
Mailing Address - Country:US
Mailing Address - Phone:970-874-2463
Mailing Address - Fax:970-874-2477
Practice Address - Street 1:70 STAFFORD LN
Practice Address - Street 2:SUITE 103
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2282
Practice Address - Country:US
Practice Address - Phone:970-874-2463
Practice Address - Fax:970-874-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONO STATE LICENSURE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00480OtherHOME HEALTH PROVIDER #
CO05700174Medicaid
CO041101OtherSTATE LICENSE