Provider Demographics
NPI:1316132988
Name:H DOUGLAS HORNBECK
Entity type:Organization
Organization Name:H DOUGLAS HORNBECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:H DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA
Authorized Official - Phone:330-270-5454
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-0881
Mailing Address - Country:US
Mailing Address - Phone:440-992-9777
Mailing Address - Fax:440-992-9683
Practice Address - Street 1:4510 COLLINS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6954
Practice Address - Country:US
Practice Address - Phone:330-270-5454
Practice Address - Fax:330-270-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000199668OtherANTHEM
OHSP00131OtherMEDICARE PTAN
OHSP00131OtherMEDICARE PTAN