Provider Demographics
NPI:1629216684
Name:DEFIANCE HOSPITAL, INC.
Entity Type:Organization
Organization Name:DEFIANCE HOSPITAL, INC.
Other - Org Name:DEFIANCE REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7576
Mailing Address - Street 1:851 S CLINTON ST
Mailing Address - Street 2:ATTEN; CBO
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2770
Mailing Address - Country:US
Mailing Address - Phone:419-824-7576
Mailing Address - Fax:419-824-3460
Practice Address - Street 1:851 S CLINTON ST
Practice Address - Street 2:ATTEN: CBO
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2770
Practice Address - Country:US
Practice Address - Phone:419-824-7576
Practice Address - Fax:419-824-3460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMEDICA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-29
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1160261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3065981Medicaid
OH3065981Medicaid