Provider Demographics
NPI:1568840452
Name:ROYAL DELI FOODS
Entity Type:Organization
Organization Name:ROYAL DELI FOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-874-7451
Mailing Address - Street 1:112 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1427
Mailing Address - Country:US
Mailing Address - Phone:419-874-7451
Mailing Address - Fax:419-874-8218
Practice Address - Street 1:112 W FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1427
Practice Address - Country:US
Practice Address - Phone:419-874-7451
Practice Address - Fax:419-874-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111371Medicaid