Provider Demographics
NPI:1609420603
Name:MERCY HEALTH - DEFIANCE HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH - DEFIANCE HOSPITAL LLC
Other - Org Name:MERCY HEALTH - DEFIANCE HOSPITAL FAMILY MEDICINE, ADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-785-3983
Mailing Address - Street 1:604 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1041
Practice Address - Country:US
Practice Address - Phone:419-634-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health