Provider Demographics
NPI:1316056252
Name:HORNBECK ASSOCIATES, LTD.
Entity type:Organization
Organization Name:HORNBECK ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HORNBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-992-9777
Mailing Address - Street 1:4510 COLLINS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6954
Mailing Address - Country:US
Mailing Address - Phone:440-992-9777
Mailing Address - Fax:440-992-9683
Practice Address - Street 1:4510 COLLINS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6954
Practice Address - Country:US
Practice Address - Phone:440-992-9777
Practice Address - Fax:440-992-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 42391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW18513Medicare PIN