Basic Information
Provider Information | |||||||||
NPI: | 1750345765 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | JTDMH TRANSITIONAL CARE UNIT | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 SAINT CLAIR AVE | ||||||||
Address2: |   | ||||||||
City: | ST MARYS | ||||||||
State: | OH | ||||||||
PostalCode: | 458852400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193943335 | ||||||||
FaxNumber: | 4193948485 | ||||||||
Practice Location | |||||||||
Address1: | 200 SAINT CLAIR AVE | ||||||||
Address2: |   | ||||||||
City: | ST MARYS | ||||||||
State: | OH | ||||||||
PostalCode: | 458852400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193943335 | ||||||||
FaxNumber: | 4193948485 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/14/2006 | ||||||||
LastUpdateDate: | 03/23/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | POHL | ||||||||
AuthorizedOfficialFirstName: | TRICIA | ||||||||
AuthorizedOfficialMiddleName: | ANN | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 4193943387 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/23/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   |   | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.