Basic Information
| Provider Information | |||||||||
| NPI: | 1871809848 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YOUNGSTOWN OHIO HOSPITAL COMPANY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHSIDE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16964 COLLECTIONS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606930001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308845879 | ||||||||
| FaxNumber: | 3308845735 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 GYPSY LN | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445041315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308845879 | ||||||||
| FaxNumber: | 3308845735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 08/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOLTSFORD | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTH OFFICIAL/DIR BUSINESS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 6154657488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | YOUNGSTOWN OHIO HOSPITAL COMPANY LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.