Warren General Hospital
Organization Active NPI Substance Use Disorder Rehabilitation Hospital Unit · Warren, PA
NPI 1376497362 · NPPES record last updated Sep 9, 2026
Key facts
- NPI
- 1376497362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Hospital Unit 276400000X
- Legal business name
- WARREN GENERAL HOSPITAL
- Practice address
- 2 W Crescent Park RM 3D
Warren, PA 16365-2111 - Phone
- (814) 723-7580
- NPI assigned
- Feb 25, 2026
- Organization subpart
- Yes
- Parent organization (as reported)
- WARREN GENERAL HOSPITAL
Authorized official
- Name
- Lisa M Ristau
- Title
- Dir of Patient Accts
- Phone
- (814) 723-4973
Owners & managing parties with NPI records 4
-
Trevor Michael Olsen, M.D.
-
Vikas Sacher, MBBS
-
Mason Tootell, M.D.
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 16
Related certifications (CCN) 3
Affiliated clinicians 199
-
Manushi Aggarwal, MD
-
Kristi L Althof, CRNP
-
Molly A Amann, CRNP
-
Abasin Amanzai, MD
-
Simon Levi Amsdell, M.D.
-
Ashish Bagal, MD, PHD
-
Heather Ann Bazurto, FNP-C
-
Gunnar Eo Bergqvist, M.D.
-
Lance Bodily, M.D.
-
Aneel Kumar Bole, M.D.
-
Andrew Timothy Braun, P.A.-C.
-
Kathe S Bryson, M.D.
-
Vladislava Buntic, M.D.
-
Heather California, CRNP, FNP-C
-
Megan Sue Church, DO
-
Taylor Glaser Coffman, PA-C
-
Bryan Colligan, DO
-
Irma Cosic, PA-C
-
Tiffany E Cummings, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Hospital certification: CCN 391319
- Legal name
- WARREN GENERAL HOSPITAL
- Doing business as
- D/B/A LECOM HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jan 14, 2026
- Last certification
- Dec 29, 2025
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 2 W Crescent Park
Warren, PA 16365-2111
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| Care Corporation of Warren |
5% Or Greater Direct Ownership Interest | Apr 13, 1987 | 55% |
| Laurie Macdonald |
Corporate Officer |
May 15, 2023 | |
| Operational/Managerial Control |
May 15, 2023 | ||
| Allegheny Health Network |
5% Or Greater Indirect Ownership Interest | Aug 31, 2018 | 22.5% |
| Julia McTavish |
Other |
Sep 1, 2018 | |
| Vikas Sacher |
Other |
Jan 1, 2025 | |
| Lecom Health Affiliates, LLC |
5% Or Greater Indirect Ownership Interest | Aug 31, 2018 | 22.5% |
| Highmark Health |
5% Or Greater Indirect Ownership Interest | Aug 31, 2018 | 22.5% |
| Mason Tootell |
Other |
Sep 1, 2018 | |
| Gwendolynn Scutella |
Other |
Jul 1, 2024 | |
| Ahn-Lecom JV LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2018 | 45% |
| Timothy Scott Stanton |
Other |
Sep 1, 2018 | |
| Kathryn Carlson |
Corporate Officer |
Jul 1, 2025 | |
| Operational/Managerial Control |
Jul 1, 2025 | ||
| Brian Devine |
Other |
Dec 19, 2023 | |
| Thad Turner |
Other |
Sep 1, 2018 | |
| Timothy Bevevino |
Other |
Sep 1, 2018 | |
| Millcreek Health System |
5% Or Greater Indirect Ownership Interest | Aug 31, 2018 | 22.5% |
| Steven Inman |
Other |
Dec 19, 2023 | |
| Karen Surkala |
Other |
Apr 23, 2020 | |
| Trevor Olsen |
Other |
Sep 1, 2018 | |
| Joseph J Maljovec |
Other |
Jan 1, 2020 | |
| Whitney Morrison |
Other |
Aug 8, 2022 | |
| Jasen Diley |
Other |
Sep 1, 2018 | |
| Randall Scalise |
Other |
Mar 2, 2022 | |
| Daniel W Grolemund |
Corporate Officer |
Jul 1, 2025 | |
| W-2 Managing Employee |
Jul 1, 2025 | 100% | |
| Operational/Managerial Control |
Jul 1, 2025 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250918000042 | PA | Part a Provider - Critical Access Hospital | 4880501402 |
Receives reassigned benefits from 1 practitioner 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Youngsville, PA; Warren, PA |
National Provider Directory
- Tax ID family
- Warren General Hosp Lab
- Part of
- Warren General Hosp Lab
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Hospital Unit | 276400000X | Yes | ||
| General Acute Care Hospital | 282N00000X |
Addresses
Primary practice location
2 W Crescent Park RM 3D
Warren, PA 16365-2111
Mailing address
2 W Crescent Park RM 3D
Warren, PA 16365-2111
Phone (814) 406-0035
Other names
- Detox Services
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All providers in Warren, PA · Substance Use Disorder Rehabilitation Hospital Unit in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.