Organization
MARY MCLEOD-BETHUNE INTERVENTION & ENRICHMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERYL LOVELY (PRESIDENT)
(419) 545-5041
Entity
Organization
Contact information
Practice address
271 HEDGES ST, MANSFIELD, OH 44902-8611
(419) 545-4021
(419) 529-3488
Mailing address
PO BOX 5503, MANSFIELD, OH 44901-5503
(419) 545-4021
(419) 529-3488
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
705115
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2764469
—
OH
Enumeration date
08/21/2014
Last updated
08/21/2014
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