=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053376343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST OHIO REGIONAL HOSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 N 4TH ST
-----------------------------------------------------
City | MARTINS FERRY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-633-1100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 EOFF ST
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-633-1100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER APPLICATION
-----------------------------------------------------
Name | SHARON MARIE EBBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-234-8663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1114
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------