Provider Demographics
NPI:1376569863
Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Other - Org Name:MERCY HEALTH-HOME HEALTH, LIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-226-9103
Mailing Address - Street 1:PO BOX 636834
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6834
Mailing Address - Country:US
Mailing Address - Phone:419-226-9062
Mailing Address - Fax:419-226-9281
Practice Address - Street 1:959 W NORTH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-226-9062
Practice Address - Fax:419-226-9281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH-ST RITAS MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0641023Medicaid
OH0641023Medicaid