Provider Demographics
NPI:1629009964
Name:MERCY HEALTH YOUNGSTOWN LLC
Entity Type:Organization
Organization Name:MERCY HEALTH YOUNGSTOWN LLC
Other - Org Name:MERCY HEALTH ST JOSEPH WARREN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:PO BOX 636469
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6469
Mailing Address - Country:US
Mailing Address - Phone:330-306-5010
Mailing Address - Fax:
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-884-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1036195OtherGATEWAY-OH
OH244548000OtherMAGELLAN
OH6461115OtherAETNA
145898OtherMAMMOGRAPHY
OH366077000OtherUS DEPT OF LABOR
OH5000133OtherUNITED HEALTH CARE
3600341782OtherCLIA (CMS)
OH000000155282OtherANTHEM
OH0265547Medicaid
OH1007751650011OtherMAPA
OH3500219OtherUNITED HEALTH CARE
OH000000073247OtherUNISON
OH000000156989OtherANTHEM
OH02-0903950OtherPHARMACY
OH0265547Medicaid
OH000000156989OtherANTHEM
OH6461115OtherAETNA
OH0265547Medicaid
3600341782OtherCLIA (CMS)