Organization
PHOENIX RESIDENTIAL CENTERS, INC.
Active
Other names
Heisley Family Home
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY JO JASKELA (CONTROLLER)
(440) 428-9082
Entity
Organization
Contact information
Practice address
5422 W HEISLEY RD, MENTOR, OH 44060-1751
(440) 352-1105
Mailing address
PO BOX 40, MADISON, OH 44057-0040
(440) 428-9082
(440) 428-5399
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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