Provider Demographics
NPI:1720036932
Name:CONNEAUT CITY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CONNEAUT CITY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:440-593-3087
Mailing Address - Street 1:327 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030
Mailing Address - Country:US
Mailing Address - Phone:440-593-3087
Mailing Address - Fax:440-593-6026
Practice Address - Street 1:327 MILL ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2439
Practice Address - Country:US
Practice Address - Phone:440-593-3087
Practice Address - Fax:440-593-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0666748Medicaid
OH0666748Medicaid