Provider Demographics
NPI:1619120995
Name:FOSTORIA HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:FOSTORIA HOSPITAL ASSOCIATION
Other - Org Name:FOSTORIA HOMECARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, FOSTORIA HOSPITAL ASSOC
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4199-436-6649
Mailing Address - Street 1:601 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1592
Mailing Address - Country:US
Mailing Address - Phone:419-435-1832
Mailing Address - Fax:419-435-9511
Practice Address - Street 1:601 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1592
Practice Address - Country:US
Practice Address - Phone:419-435-1832
Practice Address - Fax:419-435-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0164HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based