Provider Demographics
NPI:1700972601
Name:AULTMAN HOSPITAL
Entity Type:Organization
Organization Name:AULTMAN HOSPITAL
Other - Org Name:AULTMAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-479-4800
Mailing Address - Street 1:2821 WOODLAWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1423
Mailing Address - Country:US
Mailing Address - Phone:330-479-4800
Mailing Address - Fax:330-479-4804
Practice Address - Street 1:2821 WOODLAWN AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1423
Practice Address - Country:US
Practice Address - Phone:330-479-4800
Practice Address - Fax:330-479-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0066HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0863678Medicaid
OH0863678Medicaid