Provider Demographics
NPI:1407188857
Name:WARREN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WARREN GENERAL HOSPITAL
Other - Org Name:DETOX UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC. DIR FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-723-3300
Mailing Address - Street 1:TWO CRESCENT PARK W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2111
Mailing Address - Country:US
Mailing Address - Phone:814-723-3300
Mailing Address - Fax:814-723-8515
Practice Address - Street 1:TWO CRESCENT PARK W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:814-723-8515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARREN GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-10
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJJ96601276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1254OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA1254OtherHIGHMARK BLUE CROSS BLUE SHIELD