Provider Demographics
NPI:1790761922
Name:ASHTABULA COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:ASHTABULA COUNTY MEDICAL CENTER
Other - Org Name:GLENBEIGH HEALTH SOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-710-3204
Mailing Address - Street 1:2863 STATE ROUTE 45 N
Mailing Address - Street 2:P.O. BOX 298
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9352
Mailing Address - Country:US
Mailing Address - Phone:440-563-3400
Mailing Address - Fax:440-563-9363
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:P O BO 298
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-563-3400
Practice Address - Fax:440-563-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6713284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH360245Medicare ID - Type Unspecified