Provider Demographics
NPI:1962656496
Name:COMPANY CARE CENTER
Entity Type:Organization
Organization Name:COMPANY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF SUPPORT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-674-1584
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610-0428
Mailing Address - Country:US
Mailing Address - Phone:330-893-1318
Mailing Address - Fax:
Practice Address - Street 1:4900 OAK STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610
Practice Address - Country:US
Practice Address - Phone:330-893-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL POMERENE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH268508858-00OtherOHIO BUREAU OF WORKMANS COMPENSATION