Provider Demographics
NPI:1558414615
Name:CLINTON MEMORIAL HOSPITAL OF WILMINGTON CLINTON COUNTY OHIO
Entity Type:Organization
Organization Name:CLINTON MEMORIAL HOSPITAL OF WILMINGTON CLINTON COUNTY OHIO
Other - Org Name:CMH HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHADOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-382-9205
Mailing Address - Street 1:610 W MAIN ST
Mailing Address - Street 2:P.O. BOX 100
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2125
Mailing Address - Country:US
Mailing Address - Phone:937-382-6611
Mailing Address - Fax:937-382-6633
Practice Address - Street 1:761 S NELSON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2517
Practice Address - Country:US
Practice Address - Phone:937-283-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586192Medicaid
OH36-7240Medicare ID - Type UnspecifiedPROVIDER NUMBER