Basic Information
| Provider Information | |||||||||
| NPI: | 1154523827 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BARBERTON CITIZENS HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ANNA DEAN THERAPY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 363 HIGHLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | WADSWORTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303360182 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28 CONSERVATORY DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306155000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | JUSTINE | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CERTIFIED ATHLETIC TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 3306155000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | A.T.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000997 | OH | Y | Hospitals | General Acute Care Hospital |
No ID Information.