Organization
MADISON VILLAGE MANOR, INC
Active
Parent organization
MADISON VILLAGE MANOR, INC
Other names
The Gables
Organization subpart
Yes
Provider details
NPI number
Legal business name
MADISON VILLAGE MANOR, INC
Authorized official
MR. ANTHONY MICHAEL SERRA NHA (ADMINISTRATOR)
(440) 428-1519
Entity
Organization
Contact information
Practice address
731 N LAKE ST, MADISON, OH 44057-3152
(440) 428-1519
(440) 428-6360
Mailing address
PO BOX 272, 731 LAKE STREET, MADISON, OH 44057-0272
(440) 428-1519
(440) 428-6360
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
4310178
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1724665
—
OH
Enumeration date
12/15/2007
Last updated
12/15/2007
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