Healthcare Provider Details

I. General information

NPI: 1366487050
Provider Name (Legal Business Name): MERCY HEALTH YOUNGSTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EASTLAND AVE SE
WARREN OH
44484-4503
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4000
  • Fax: 330-884-7107
Mailing address:
  • Phone: 330-884-7055
  • Fax: 330-884-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. R. ANDREW BROTHERS
Title or Position: SR. VP AND CFO
Credential:
Phone: 330-884-7055