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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