Healthcare Provider Details

I. General information

NPI: 1033210844
Provider Name (Legal Business Name): MIDWEST HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LINCOLN WAY W 5A
MASSILLON OH
44647-6585
US

IV. Provider business mailing address

11 LINCOLN WAY W 5A
MASSILLON OH
44647-6585
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-9582
  • Fax: 330-833-1305
Mailing address:
  • Phone: 330-832-9582
  • Fax: 330-833-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. CONNIE A HORNBECK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 330-832-9582