Basic Information
| Provider Information | |||||||||
| NPI: | 1023193992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLANCHARD VALLEY REGIONAL HEALTH CENTER | ||||||||
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| OtherOrganizationName: | BLANCHARD VALLEY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SOUTH MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235262 | ||||||||
| FaxNumber: | 4194235550 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 SOUTH MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235262 | ||||||||
| FaxNumber: | 4194235550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 02/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | CYTLAK | ||||||||
| AuthorizedOfficialFirstName: | DAVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4194235497 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | PPH 04-2423 | OH | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 0759666 | 05 | OH | MEDICAID |