Basic Information
| Provider Information | |||||||||
| NPI: | 1558414615 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINTON MEMORIAL HOSPITAL OF WILMINGTON CLINTON COUNTY OHIO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CMH HOME HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 W MAIN ST | ||||||||
| Address2: | P.O. BOX 100 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373826611 | ||||||||
| FaxNumber: | 9373826633 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 S NELSON AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451772517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372839650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHADOWENS | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP AND CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9373829205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0586192 | 05 | OH | MEDICAID |