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General NPI Number Information
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NPI Number | 1659387991
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Entity Type | Organization
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Legal Business Name | MERCY HEALTH-ST CHARLES HOSPITAL LLC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2600 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3207
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Country | US
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Telephone | 419-696-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3207
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Country | US
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Telephone | 419-696-7411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | STEVEN L MICKUS
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Credential |
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Telephone | 419-251-8944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | OH
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