PHOENIX RESIDENTIAL CENTERS, INC. (NPI# 1821429267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821429267 |
| Entity Type | Organization |
| Organization Name | PHOENIX RESIDENTIAL CENTERS, INC. |
| Other Organization Name | HEISLEY FAMILY HOME |
| Practice Address |
5422 W Heisley Rd Mentor OH 44060-1751 |
| Mailing Address |
Po Box 40 Madison OH 44057-0040 |
| Practice Telephone | 4403521105 |
| Mailing Telephone | 4404289082 |
| Mailing Fax Number | 4404285399 |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2013-12-11 |
| Authorized Official Name | MRS. MARY JO JASKELA (CONTROLLER) |
| Authorized Official Telephone | 4404289082 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Heisley Family Home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629467972 | Phoenix Residential Centers, Inc. | Intermediate Care Facility, Mentally Retarded | 12345 Meredith Ln, Painesville, OH 44077-9246 | 2015-01-09 |
| 1275873317 | Phoenix Residential Centers, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5278 Lockwood Rd, Madison, OH 44057-2313 | 2013-02-27 |
| Street Address |
5422 W HEISLEY RD |
| City | MENTOR |
| State | OH |
| Zip Code | 44060-1751 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902439144 | Viaquest Healthcare Central | Intermediate Care Facility, Mentally Retarded | 5422 W Heisley Rd, Mentor, OH 44060-1751 | 2020-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093364143 | Pamela Adams | Technician | 6079 Center St, Mentor, OH 44060 | 2019-09-10 |
| 1255800298 | Brittani Joy Lumpkin | Community/Behavioral Health | 9220 Mentor Road., Mentor, OH 44060 | 2018-11-20 |
| 1043726763 | Sharon Bollinger | Counselor | 7232 Tyler Blvd., Mentor, OH 44060 | 2017-12-18 |
| 1255863635 | Mentor Health and Rehabilitation Center, Inc. | Skilled Nursing Facility | 8151 Norton Pkwy, Mentor, OH 44060 | 2017-04-03 |
| 1144695933 | Kirsten Lorek | Specialist/Technologist | 8400 Paddock Ct, Mentor, OH 44060 | 2015-12-06 |
| 1346638848 | Darlean Williams | Licensed Practical Nurse | 6477 Center Street, Mentor High School, Mentor, OH 44060 | 2015-01-06 |
| 1316357130 | Kathryn Arnette Romo | Speech-Language Pathologist | 6451 Center Street, Mentor Exempted Village Schools, Mentor, OH 44060 | 2014-05-01 |
| 1730599705 | Marianne. P. Kostiha | Registered Nurse | 6451 Center St., Mentor Public Schools, Mentor, OH 44060 | 2014-04-30 |
| 1558788190 | Jeanne Marie Markusic | Physical Therapist | 7687 Ellington Pl, Mentor, OH 44060 | 2014-03-20 |
| 1477979391 | Center for Advanced Vein Care LLC | Emergency Medicine | 7200 Mentor Avenue, Mentor, OH 44060 | 2014-03-17 |
| Find all providers in zip 44060 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366043341 | Denise Szabados | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 802 Valley Dr, Amherst, OH 44001-2041 | 2020-11-05 |
| 1093316374 | Collene Marie Hill | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 06605 Cr 8, Bryan, OH 43506-4350 | 2020-11-04 |
| 1467052050 | Kathryn Mooers Howitt | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 374 Woodlawn Reserve Rd, Akron, OH 44305-3959 | 2020-11-01 |
| 1679173629 | The Resource Empowerment Center LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3895 S Main St, Akron, OH 44319-3630 | 2020-10-29 |
| 1104426667 | Highest Expectations LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 25 W South St, Lebanon, OH 45036-2127 | 2020-10-26 |
| 1982203964 | Family Care Supportive Living LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5012 Saint Aubin Dr, Toledo, OH 43615-5913 | 2020-10-21 |
| 1699374082 | Pamela Wilkes | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 116 Washburn Rd, Tallmadge, OH 44278-2612 | 2020-10-18 |
| 1073111654 | Mary V Byrd | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 37 Sterling Rd, Marietta, OH 45750 | 2020-10-15 |
| 1558969477 | Caryl Westgerdes | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3064 Eagle Cove Dr, Ripley, OH 45167-9683 | 2020-10-13 |
| 1972101210 | Nakia Sullins | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6033 Bear Creek Dr Apt 210, Bedford Heights, OH 44146-2907 | 2020-10-09 |
| Find all providers with the same taxonomy | ||||
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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.