Provider Demographics
NPI:1760409221
Name:BARBERTON HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:BARBERTON HEALTH SYSTEM LLC
Other - Org Name:BARBERTON CITIZENS HOSPITAL PSYCHIATRIC UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 714139
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4139
Mailing Address - Country:US
Mailing Address - Phone:330-745-1611
Mailing Address - Fax:330-848-7820
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:330-745-1611
Practice Address - Fax:330-848-7820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARBERTON HEALTH SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPPH03-2413273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0341848Medicaid
36S019Medicare Oscar/Certification