Provider Demographics
NPI:1033554233
Name:DELTA HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:DELTA HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVEN-EMOND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:970-964-7740
Mailing Address - Street 1:1025 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416
Mailing Address - Country:US
Mailing Address - Phone:970-964-7740
Mailing Address - Fax:970-874-6330
Practice Address - Street 1:1025 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-964-7740
Practice Address - Fax:970-874-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN 2573364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29826861Medicaid
CO313613Medicare PIN