Provider Demographics
NPI:1235150954
Name:SHARON REGIONAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:SHARON REGIONAL HEALTH SYSTEM
Other - Org Name:SRHS OUTPT D & A - COP & IOP
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHROBAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-983-3815
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3817
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:2375 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-983-5454
Practice Address - Fax:724-983-5428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARON REGIONAL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-21
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA437016251S00000X
437016261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000000590014Medicaid
PA1000000590104Medicaid