# ST. JOHN'S VILLA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174691927
- **Authorized official:** DAVID L. LYON (PRESIDENT)
- **Authorized official phone:** (330) 627-9789

## Contact information

- **Practice address:** 701 CREST ST NW, CARROLLTON, OH 44615-8425
- **Practice address phone:** (330) 627-9789
- **Practice address fax:** (330) 627-4826
- **Mailing address:** 701 CREST ST NW, PO BOX 457, CARROLLTON, OH 44615-8425
- **Mailing address phone:** (330) 627-9789
- **Mailing address fax:** (330) 627-4826

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 1010128 | OH | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 06/16/2008