Provider Demographics
NPI:1306938345
Name:MERCY HEALTH YOUNGSTOWN LLC
Entity type:Organization
Organization Name:MERCY HEALTH YOUNGSTOWN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-480-4598
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-0207
Mailing Address - Country:US
Mailing Address - Phone:330-480-3682
Mailing Address - Fax:330-480-2750
Practice Address - Street 1:979 TIBBETTS WICK RD
Practice Address - Street 2:SUITE A
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1182
Practice Address - Country:US
Practice Address - Phone:330-480-3682
Practice Address - Fax:330-480-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-09459503336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287158Medicaid
OH0287158Medicaid