Provider Demographics
NPI:1780818963
Name:MERCY HEALTH-ALLEN HOSPITAL LLC
Entity Type:Organization
Organization Name:MERCY HEALTH-ALLEN HOSPITAL LLC
Other - Org Name:MH-WELLINGTON PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REIMBURSEMENT
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 636573
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:440-988-1009
Mailing Address - Fax:440-988-1225
Practice Address - Street 1:840 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090
Practice Address - Country:US
Practice Address - Phone:440-647-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH LORAIN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-04
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062505Medicaid
OH363988Medicare Oscar/Certification