Provider Demographics
NPI:1578692273
Name:GEAUGA COUNTY HEALTH DISTRICT
Entity Type:Organization
Organization Name:GEAUGA COUNTY HEALTH DISTRICT
Other - Org Name:GEAUGA COUNTY COMBINED HEALTH DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISDACK
Authorized Official - Suffix:
Authorized Official - Credentials:RS, MA, MPH
Authorized Official - Phone:440-279-1900
Mailing Address - Street 1:470 CENTER ST BLDG 8
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1071
Mailing Address - Country:US
Mailing Address - Phone:440-279-1900
Mailing Address - Fax:440-286-1290
Practice Address - Street 1:470 CENTER ST BLDG 8
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1071
Practice Address - Country:US
Practice Address - Phone:440-279-1900
Practice Address - Fax:440-286-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0980372Medicaid
OHFV91311Medicare ID - Type Unspecified