Provider Demographics
NPI:1952641474
Name:DELTA HST, LTD
Entity Type:Organization
Organization Name:DELTA HST, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-757-3166
Mailing Address - Street 1:3296 STONES THROW AVE
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4213
Mailing Address - Country:US
Mailing Address - Phone:330-757-3166
Mailing Address - Fax:
Practice Address - Street 1:3296 STONES THROW AVE
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4213
Practice Address - Country:US
Practice Address - Phone:330-757-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic