Organization
WAYNE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CLEVELAND (OWNER)
(419) 210-4649
Entity
Organization
Contact information
Practice address
898 TOWNSHIP ROAD 210, MARENGO, OH 43334-9623
(419) 210-4645
Mailing address
898 TOWNSHIP ROAD 210, MARENGO, OH 43334-9623
(419) 210-4645
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/05/2020
Last updated
11/05/2020
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