# MADISON VILLAGE MANOR, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MADISON VILLAGE MANOR, INC
- **Other names:** The Gables
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154504983
- **Legal business name:** MADISON VILLAGE MANOR, INC
- **Authorized official:** MR. ANTHONY MICHAEL SERRA NHA (ADMINISTRATOR)
- **Authorized official phone:** (440) 428-1519

## Contact information

- **Practice address:** 731 N LAKE ST, MADISON, OH 44057-3152
- **Practice address phone:** (440) 428-1519
- **Practice address fax:** (440) 428-6360
- **Mailing address:** PO BOX 272, 731 LAKE STREET, MADISON, OH 44057-0272
- **Mailing address phone:** (440) 428-1519
- **Mailing address fax:** (440) 428-6360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 4310178 | OH | Yes |

## Other

- **Enumeration date:** 12/15/2007
- **Last updated:** 12/15/2007