MADISON VILLAGE MANOR, INC (NPI# 1154504983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154504983 |
Entity Type | Organization |
Organization Name | MADISON VILLAGE MANOR, INC |
Other Organization Name | THE GABLES |
Practice Address |
731 N Lake St Madison OH 44057-3152 |
Mailing Address |
Po Box 272 731 Lake Street Madison OH 44057-0272 |
Practice Telephone | 4404281519 |
Practice Fax Number | 4404286360 |
Mailing Telephone | 4404281519 |
Mailing Fax Number | 4404286360 |
Enumeration Date | 2007-12-15 |
Last Update Date | 2007-12-15 |
Authorized Official Name | MR. ANTHONY MICHAEL SERRA (ADMINISTRATOR) |
Authorized Official Telephone | 4404281519 |
Authorized Official Credential | NHA |
Is Organization Subpart | Y |
Parent Organization Name | MADISON VILLAGE MANOR, INC |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4310178 | OH | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OH | 1724665 | 05 |
Other Name | Type Code |
---|---|
The Gables | Doing Business As Name - Organization |
Street Address |
731 N LAKE ST |
City | MADISON |
State | OH |
Zip Code | 44057-3152 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376028332 | Charlotte F Kister | Assisted Living Facility | 2358 Hubbard Road, Madison, OH 44057 | 2018-09-26 |
1861862336 | Living Opportunities, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6873 Dave Drive, Madison, OH 44057 | 2015-09-28 |
1548526650 | Jessica Cook | Family Medicine | 6270 North Ridge Rd, Madison, OH 44057 | 2012-04-03 |
1164651428 | Dr. Edward S. Friedman, Optometrist Inc. | Optometrist | 6067 North Ridge Rd., Madison, OH 44057 | 2009-07-08 |
1023259546 | Northern Dental Specialists, Dr. Steven W Gajda | Dentist | 2040 Hubbard Road, Madison, OH 44057 | 2009-03-12 |
1295908267 | Nathan Tekavec | Physical Therapist | 2583 Walter Green Commons, Madison, OH 44057 | 2008-04-10 |
1124228556 | Alan B Spiegel | Pediatrics | 6270 N. Ridge Road, Lake Health Physician Group Madison Pediatrics, Madison, OH 44057 | 2007-07-24 |
1083828149 | Mary Kathleen Tascone | Registered Nurse | 6205 Campbell Dr, Madison, OH 44057 | 2007-05-09 |
1801016043 | Donna Marie Jones | Home Health Aide | 6082 N Ridge Rd, Madison, OH 44057 | 2007-04-30 |
1356466445 | Kist Family Chiropractic & Wellness Centre Inc. | Chiropractor | 2711 Hubbard Rd, Madison, OH 44057 | 2007-03-20 |
Find all providers in zip 44057 |
Taxonomy Code | 320600000X |
Grouping | Residential Treatment Facilities |
Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801256755 | Alpha & Omega Home/healthcare Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 401 W Old Hickory Blvd, Madison, TN 37115-3609 | 2016-03-03 |
1932328572 | Grand Manner, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1954 Hubbard Rd, Madison, OH 44057-2154 | 2007-04-24 |
1356484315 | Living Opportunities Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3142 County Line Rd, Madison, OH 44057-9705 | 2007-02-15 |
1972786705 | Madison Village Manor | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 148 E Main St, Madison, OH 44057-3226 | 2007-12-15 |
1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
1386705655 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2006-12-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467053801 | Vip of Ohio, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2446 Audubon Rd, Akron, OH 44320-1010 | 2020-11-03 |
1871190280 | Gateways To Better Living Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6000 Mahoning Ave Ste 234, Youngstown, OH 44515-2225 | 2020-10-08 |
1235746264 | Cheryl L Nelson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 21891 Ringgold Southern Rd, Circleville, OH 43113-9263 | 2020-09-24 |
1164039244 | Amberdawn E Kenworthy-byers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3746 Hickory Ln, Greenville, OH 45331-3014 | 2020-09-23 |
1467067124 | Forever Care LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5240 Northtowne Blvd Apt C, Columbus, OH 43229-4661 | 2020-09-10 |
1174177737 | Alive Now Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6717 Amsel Ave Ne, Canton, OH 44721-2606 | 2019-07-31 |
1154846095 | Anitra L Richardson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3321 Hackberry St, Cincinnati, OH 45207-1701 | 2017-08-11 |
1811447519 | Royal Queens Care Agency | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6625 Retton Rd, Reynoldsburg, OH 43068-2849 | 2016-10-06 |
1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
1700238391 | Rose-mary, The Johanna Grasselli Rehabilitation and Education Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4383 Ammon Rd, Cleveland, OH 44143-2803 | 2016-07-07 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.