Basic Information
| Provider Information | |||||||||
| NPI: | 1265421721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARREN GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CRESCENT PARK WEST | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163652111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147233300 | ||||||||
| FaxNumber: | 8147238515 | ||||||||
| Practice Location | |||||||||
| Address1: | TWO CRESCENT PARK W | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163650068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147233300 | ||||||||
| FaxNumber: | 8147238515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | JACOBS | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. DIRECTOR FISCAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8147233300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WARREN GENERAL HOSPITAL | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 940570 | PA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 105201 | 01 | UPMC | OTHER | 1007284970014 | 05 | PA | MEDICAID | 00011455501 | 01 | UNIVERA | OTHER | 0929 | 01 | PA | BLUE CROSS | OTHER |