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General NPI Number Information
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NPI Number | 1285762450
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Entity Type | Organization
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Legal Business Name | OAK GROVE MANOR MRDD
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1670 CRIDER RD
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City | MANSFIELD
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State | OH
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Zip | 44903-9268
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Country | US
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Telephone | 614-459-2482
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Fax | 614-459-2641
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Provider Business Mailing Address
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Address Line | 1661 OLD HENDERSON RD
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City | COLUMBUS
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State | OH
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Zip | 43220-3644
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Country | US
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Telephone | 614-459-2482
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Fax | 614-459-2641
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Authorized Official
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Title or Position | CONTROLLER
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Name | OSCAR G ALEMAN
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Credential |
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Telephone | 614-459-2482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 1783N
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License Number State | OH
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