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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