Provider Demographics
NPI:1568425650
Name:AULTMAN SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:AULTMAN SPECIALTY HOSPITAL LLC
Other - Org Name:ACUTE CARE SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:REGULA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:330-363-3179
Mailing Address - Street 1:2600 6TH ST SW
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1799
Mailing Address - Country:US
Mailing Address - Phone:330-363-4000
Mailing Address - Fax:330-363-4001
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-4000
Practice Address - Fax:330-363-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2573559Medicaid
OH2573559Medicaid