Provider Demographics
NPI:1235355264
Name:NORTHWOOD HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:NORTHWOOD HEALTH SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:RADAKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-234-3500
Mailing Address - Street 1:111 19TH ST
Mailing Address - Street 2:PO BOX 6400
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3709
Mailing Address - Country:US
Mailing Address - Phone:304-234-3500
Mailing Address - Fax:304-234-3511
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV013261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005467002Medicaid
WV9925591Medicare PIN