Provider Demographics
NPI:1033210844
Name:MIDWEST HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MIDWEST HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORNBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-832-9582
Mailing Address - Street 1:11 LINCOLN WAY W
Mailing Address - Street 2:5A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6585
Mailing Address - Country:US
Mailing Address - Phone:330-832-9582
Mailing Address - Fax:330-833-1305
Practice Address - Street 1:11 LINCOLN WAY W
Practice Address - Street 2:5A
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6585
Practice Address - Country:US
Practice Address - Phone:330-832-9582
Practice Address - Fax:330-833-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM8500321OtherCONTRACT NUMBER ODMRDD