Provider Demographics
NPI:1629010251
Name:FORUM HEALTH REHABILITATIVE SERVICES CO.
Entity Type:Organization
Organization Name:FORUM HEALTH REHABILITATIVE SERVICES CO.
Other - Org Name:HILLSIDE REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, CRRN, CNA
Authorized Official - Phone:330-841-3720
Mailing Address - Street 1:8747 SQUIRES LN NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1649
Mailing Address - Country:US
Mailing Address - Phone:330-841-3720
Mailing Address - Fax:330-841-3647
Practice Address - Street 1:8747 SQUIRES LN NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1649
Practice Address - Country:US
Practice Address - Phone:330-841-3720
Practice Address - Fax:330-841-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3944816Medicaid
36-3026Medicare ID - Type Unspecified