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Organization
MANSFIELD GROUP HOME, LTD
Active
Organization
MANSFIELD GROUP HOME, LTD
Active
Other names
CHENITA GROUP HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY R ROBERTSON (CORP. OFFICE EXECUTIVE ASSISTANT)
(419) 526-0124
Entity
Organization
Contact information
Practice address
245 W 4TH ST, MANSFIELD, OH 44903-1704
(419) 524-2335
(419) 522-4391
Mailing address
245 W 4TH ST, MANSFIELD, OH 44903-1704
(419) 524-2335
(419) 522-4391
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
15636
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2076131
—
OH
Enumeration date
09/28/2005
Last updated
08/22/2020
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