Provider Demographics
NPI:1043297757
Name:IHS ACQUISITION NO 124 INC
Entity type:Organization
Organization Name:IHS ACQUISITION NO 124 INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR ACCOUNTING & REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-539-2362
Mailing Address - Street 1:202 WASHINGTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4735
Mailing Address - Country:US
Mailing Address - Phone:330-399-8997
Mailing Address - Fax:330-393-5889
Practice Address - Street 1:202 WASHINGTON ST NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4735
Practice Address - Country:US
Practice Address - Phone:330-399-8997
Practice Address - Fax:330-393-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5453314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570776Medicaid
OH2570776Medicaid