Provider Demographics
NPI:1417940719
Name:DELAWARE VALLEY HOSPITAL, INC
Entity Type:Organization
Organization Name:DELAWARE VALLEY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:607-865-2162
Mailing Address - Street 1:1 TITUS PL
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1457
Mailing Address - Country:US
Mailing Address - Phone:607-865-2100
Mailing Address - Fax:607-865-8990
Practice Address - Street 1:1 TITUS PL
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1457
Practice Address - Country:US
Practice Address - Phone:607-865-2100
Practice Address - Fax:607-865-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347571Medicaid
NY33Z312Medicare Oscar/Certification
NY331312Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER