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General NPI Number Information
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NPI Number | 1275756967
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Entity Type | Organization
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Legal Business Name | MUSKINGUM RESIDENTIALS, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 MONTGOMERY AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-2617
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Country | US
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Telephone | 740-453-5350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2415
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City | ZANESVILLE
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State | OH
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Zip | 43702-2415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JERRI L. ELSON
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Credential |
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Telephone | 740-453-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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