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Organization
PHOENIX RESIDENTIAL CENTERS, INC.
Active
Organization
PHOENIX RESIDENTIAL CENTERS, INC.
Active
Other names
Meredith Lane Family Home
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY JO JASKELA (CONTROLLER)
(440) 428-9082
Entity
Organization
Contact information
Practice address
12345 MEREDITH LN, PAINESVILLE, OH 44077-9246
(440) 428-9082
Mailing address
1954 HUBBARD RD, MADISON, OH 44057-2172
(440) 428-9082
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
01/09/2015
Last updated
01/09/2015
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