Provider Demographics
NPI:1790131050
Name:AVITA ONTARIO HOSPITAL
Entity Type:Organization
Organization Name:AVITA ONTARIO HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DRAIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-468-0501
Mailing Address - Street 1:269 PORTLAND WAY S
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2312
Mailing Address - Country:US
Mailing Address - Phone:419-468-4841
Mailing Address - Fax:
Practice Address - Street 1:715 RICHLAND MALL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-3802
Practice Address - Country:US
Practice Address - Phone:567-307-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVITA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital