Healthcare Provider Details

I. General information

NPI: 1427022748
Provider Name (Legal Business Name): ASHTABULA COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

IV. Provider business mailing address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-6665
  • Fax:
Mailing address:
  • Phone: 440-997-6665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number36S125
License Number StateOH

VIII. Authorized Official

Name: MISS TERRY A HOCEVAR
Title or Position: DIRECTOR PFS/REG
Credential:
Phone: 440-997-6665