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Organization
SCIOTO GROUP HOME, INC.
Active
Organization
SCIOTO GROUP HOME, INC.
Active
Other names
Scioto Trails Manor
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN COLLERAN (PRESIDENT)
(440) 614-0160
Entity
Organization
Contact information
Practice address
374 GOOD MANOR RD, LUCASVILLE, OH 45648-9606
(740) 289-2861
(440) 289-4355
Mailing address
25000 COUNTRY CLUB BLVD, STE 255, NORTH OLMSTED, OH 44070-5344
(440) 614-0160
(440) 614-0168
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6610055
DODD FACILITY NUMBER
OH
Enumeration date
12/13/2011
Last updated
12/23/2011
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