Healthcare Provider Details

I. General information

NPI: 1750100061
Provider Name (Legal Business Name): MANSFIELD AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 MIDDLE BELLVILLE RD
MANSFIELD OH
44904-1798
US

IV. Provider business mailing address

1841 MIDDLE BELLVILLE RD
MANSFIELD OH
44904-1798
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-5599
  • Fax:
Mailing address:
  • Phone: 419-756-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALAN LITT
Title or Position: CEO
Credential:
Phone: 419-756-5599