NPIMap

Organization Active NPI

Licking Memorial Hospital

  • Home Health Agency
  • Newark, OH
National Provider Identifier
1720163637
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
LICKING MEMORIAL HOSPITAL
Practice address
1865 Tamarack Rd Ste B
Newark, OH 43055-2316
Phone
(740) 348-1860
Fax
(740) 348-1861
NPI assigned
Oct 26, 2006
Organization subpart
Yes
Parent organization
LICKING MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cynthia L Webster
Title
VP Financial Services
Phone
(740) 348-4518

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X OH Primary

Addresses

Primary practice location

1865 Tamarack Rd Ste B
Newark, OH 43055-2316

Mailing address

1865 Tamarack Rd Ste B
Newark, OH 43055-2316
Phone (740) 348-1860

Other identifiers 1

IdentifierTypeStateIssuer
0869092MedicaidOH

Other names 1

  • Licking Memorial Hospital Homecare Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080408000158 OH Part A Provider - Home Health Agency 6204935786 Practice locations: Newark, OH

Home health agency certification: CCN 367475

Legal name
LICKING MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 3, 1992
Last certification
Sep 28, 2017
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Jan 13, 1899 in OH
Enrollment address
1865 Tamarack Rd
Newark, OH 43055-2305

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Licking Memorial Hospital Home CareCCN 367475
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Feb 3, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Licking Memorial Hospit6 organizations share this tax ID, including this one
Part of
Licking Memorial Hospit

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1865 Tamarack Rd
Ste B
Newark, OH 43055
Phone (740) 348-1860

Ownership & related parties

All disclosed owners & managing parties 35

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andre Sarap Individual Corporate DirectorLMH Board of Directors Apr 22, 2021
Jack Treinish Individual Corporate DirectorBoard of Directors LMH Apr 22, 2021
Craig Baldwin Individual Corporate DirectorLMHS Board of Directors Apr 26, 2016
Veronica Link Individual Corporate OfficerVP Development & PR Feb 24, 2023
Robert Montagnese Individual Operational/Managerial ControlLMH President May 22, 2014
Philip Wagner Individual Corporate DirectorBoard of Directors LMH Apr 22, 2021
Scitt Hayes Individual Corporate DirectorLMH Board of Directors Apr 25, 2018
Gregory a Wallis Individual Corporate OfficerVice President Physician Practices May 23, 2016
Cynthia Webster Individual Corporate OfficerVice President Financial Services Nov 19, 2008
Joyce Malainy Individual Corporate DirectorLMHS Board of Directors Apr 22, 2021
Alexander Miller Individual Corporate DirectorLMH Board of Directors Aug 1, 2020
Jacqueline Parrill Individual Corporate DirectorLMH Board of Directors Apr 26, 2017
Heather M Burkhart Individual Corporate OfficerVice President Acute Care Services Oct 26, 2018
William Mann Individual Corporate DirectorLMHF Board of Directors Apr 22, 2021
Linda Dalgarn Individual Corporate DirectorLMHS Board of Directors Apr 1, 2013
David Claypool Individual Corporate DirectorController Jul 3, 2002
W-2 Managing EmployeeController Jul 3, 2002
Anne Peterson Individual Corporate OfficerVice President HR and Support Jul 24, 2003
David Doney Individual Corporate DirectorLMH Board of Directors May 22, 2014
Mark a Mitchell Individual Corporate DirectorLMH Board of Directors Apr 26, 2017
Diana Ermlich Individual Corporate OfficerVice President Information Systems Nov 14, 2022
Licking Memorial Hospital Organization, Newark, OH Non-profit Operational/Managerial Control Dec 13, 2016
James Cooper Individual Corporate DirectorLMH Board of Directors Apr 26, 2017
Paul Thompson Individual Corporate DirectorLMH Board of Directors Apr 22, 2016
Sharad Thakkar Individual Corporate DirectorLMH Board of Directors Apr 15, 2015
Patrick Guanciale Individual Corporate DirectorLMHS Board of Directors Apr 1, 2014
Brian Mortellaro Individual Corporate DirectorLMHS Board of Directors Apr 22, 2021
Nancy Neely Individual Corporate DirectorLMHS Board of Directors Apr 24, 2017
Craig B Cairns Individual Corporate OfficerVice President Medical Staff Jan 21, 2004
Holly D Slaughter Individual Corporate OfficerVP Safety Security HR Nov 3, 2016
Patrick Jeffries Individual Corporate DirectorLMHF Board of Directors Apr 1, 2004
Marcia Downes Individual Corporate DirectorLMH Board of Directors Apr 1, 2020
Gordon Wilken Individual Corporate DirectorLMHF Board of Directors Apr 22, 2021
Eschol Curl Individual Corporate DirectorLMHS Board of Directors May 22, 2014
Daniel Hayes Individual Corporate DirectorLMH Board of Directors Apr 22, 2021
Michael Massaro Individual Corporate DirectorLMHS Board of Directors Apr 24, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1720163637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 TAMARACK RD STE B",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552316",
            "telephone_number": "740-348-1860",
            "fax_number": "740-348-1861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 TAMARACK RD STE B",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430552316",
            "telephone_number": "740-348-1860",
            "fax_number": "740-348-1861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LICKING MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-26",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "WEBSTER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP FINANCIAL SERVICES",
        "authorized_official_telephone_number": "740-348-4518"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0869092",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licking Memorial Hospital Homecare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.