MEDICARE: MANSFIELD LIVING CENTER, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	15637	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063409720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSFIELD LIVING CENTER, LTD

Provider Business Mailing Address
First Line	:	73 MADISON RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2830
Country	:	US
Telephone Number	:	419-526-0124
Fax Number	:	419-522-4391

Provider Business Practice Location Address
First Line	:	73 MADISON RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44905-2830
Country	:	US
Telephone Number	:	419-526-0124
Fax Number	:	419-522-4391

Authorized Official
Title or Position	:	CORP. OFFICE EXECUTIVE ASSISTANT
Name	:	MRS. TRACY R ROBERTSON
Credential	:
Telephone Number	:	419-526-0124

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	08/22/2020

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