Healthcare Provider Details

I. General information

NPI: 1124115878
Provider Name (Legal Business Name): WESTERN RESERVE CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3898
  • Fax: 330-884-5672
Mailing address:
  • Phone: 330-884-3898
  • Fax: 330-884-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MS. ROXIA B. BOYKIN
Title or Position: EXECUTIVE VICE PRESIDENT AND COO
Credential: MPA, RN, CNA
Phone: 330-884-5879