Healthcare Provider Details

I. General information

NPI: 1083218390
Provider Name (Legal Business Name): MINAMYER RESIDENTIAL CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LAKEVIEW PLAZA BLVD STE A
WORTHINGTON OH
43085-4799
US

IV. Provider business mailing address

600 LAKEVIEW PLAZA BLVD STE A
WORTHINGTON OH
43085-4799
US

V. Phone/Fax

Practice location:
  • Phone: 614-802-0190
  • Fax:
Mailing address:
  • Phone: 614-802-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN THOMPSON
Title or Position: VP CONTROLLER
Credential:
Phone: 615-948-6597