Healthcare Provider Details

I. General information

NPI: 1023361243
Provider Name (Legal Business Name): DELTA CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMMERCIAL AVE
CAIRO IL
62914-1978
US

IV. Provider business mailing address

1250 CEDAR CT PO BOX 3008
CARBONDALE IL
62901-5334
US

V. Phone/Fax

Practice location:
  • Phone: 618-734-1350
  • Fax:
Mailing address:
  • Phone: 618-457-0450
  • Fax: 618-457-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK L. BERNSTEIN
Title or Position: CEO
Credential:
Phone: 618-457-0450