Organization
COUNTY OF RICHLAND
Active
Other names
Glendale
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH G PRATHER (SUPERINTENDENT)
(419) 774-4200
Entity
Organization
Contact information
Practice address
624 GLENDALE BLVD, MANSFIELD, OH 44907-2224
(419) 774-4394
Mailing address
314 CLEVELAND AVE, MANSFIELD, OH 44902-8623
(419) 774-4200
(419) 774-4207
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511539
—
OH
Enumeration date
10/02/2007
Last updated
10/02/2007
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