MANSFIELD GROUP HOME LTD NPI 1063409738

NPI Information

NPI: 1063409738
Provider Name: MANSFIELD GROUP HOME, LTD

Doing Business As: CHENITA GROUP HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

Address:
245 W 4TH ST
MANSFIELD, OH
ZIP 44903
Phone: (419) 524-2335
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MANSFIELD GROUP HOME, LTD is an intermediate care facility mentally retarded in Mansfield, OH. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. 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 CLIA number assigned to this NPI record is 36D0873340 - prison with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2005 and was last updated on 8/22/2020.

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
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		15636	OHIO	Yes

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
1	2076131	MEDICAID	OHIO

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: 5/5/2024

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