Provider Demographics
NPI:1083843031
Name:THE TOLEDO HOSPITAL
Entity Type:Organization
Organization Name:THE TOLEDO HOSPITAL
Other - Org Name:CULLEN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-585-1964
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3846
Practice Address - Country:US
Practice Address - Phone:419-291-7919
Practice Address - Fax:419-479-3272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TOLEDO HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0005120101YP2500X
OH5415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8822662Medicaid
OH8822662Medicaid