Provider Demographics
NPI:1407115298
Name:MERIDIAN HEALTHCARE
Entity Type:Organization
Organization Name:MERIDIAN HEALTHCARE
Other - Org Name:MERIDIAN COMMUNITY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-797-0070
Mailing Address - Street 1:8255 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6483
Mailing Address - Country:US
Mailing Address - Phone:330-797-0070
Mailing Address - Fax:330-743-6672
Practice Address - Street 1:527 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1227
Practice Address - Country:US
Practice Address - Phone:330-797-0070
Practice Address - Fax:330-743-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2863781Medicaid
OHME9227381Medicare PIN