Provider Demographics
NPI:1497061477
Name:WARREN OHIO HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:WARREN OHIO HOSPITAL COMPANY LLC
Other - Org Name:TRUMBULL MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL/DIR BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:16967 COLLECTIONS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0001
Mailing Address - Country:US
Mailing Address - Phone:330-841-9820
Mailing Address - Fax:330-841-9281
Practice Address - Street 1:1350 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6608
Practice Address - Country:US
Practice Address - Phone:330-841-9820
Practice Address - Fax:330-841-9281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WARREN OHIO HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36S055Medicare Oscar/Certification