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MANSFIELD GROUP HOME LTD NPI 1063409738

NPI Profile

NPI: 1063409738
Provider Name: MANSFIELD GROUP HOME, LTD

Doing Business As: CHENITA GROUP HOME

Classification: Intermediate Care Facility, Mentally Retarded - 315P00000X
Entity Type: Organization
Address:
245 W 4TH ST
MANSFIELD, OH
ZIP 44903
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Phone: (419) 524-2335

MANSFIELD GROUP HOME, LTD is an intermediate care facility mentally retarded in Mansfield, OH. The provider is (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. MANSFIELD GROUP HOME, LTD NPI is 1063409738. The provider is registered as an organization entity type.
The provider Is Doing Business As Chenita Group Home.

The provider's business location address is:

245 W 4TH ST
MANSFIELD, OH
ZIP 44903-704
Phone: (419) 524-2335
Fax: (419) 522-4391

The provider's authorized official is Tracy R Robertson .
The authorized official title is Corp. Office Executive Assistant and has the following contact phone number (419) 526-0124.

The enumeration date for this NPI number is 9/28/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Mentally Retarded15636OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12076131MEDICAIDOHIO
236G385MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 12/11/2019

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