Provider Demographics
NPI:1396901260
Name:OGLETHORPE OF CAMBRIDGE,LLC
Entity type:Organization
Organization Name:OGLETHORPE OF CAMBRIDGE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-825-5735
Mailing Address - Street 1:13406 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6822
Mailing Address - Country:US
Mailing Address - Phone:813-978-1933
Mailing Address - Fax:813-978-1951
Practice Address - Street 1:66755 STATE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8757
Practice Address - Country:US
Practice Address - Phone:813-978-1933
Practice Address - Fax:813-978-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-4027Medicare PIN