Organization
MADISON VILLAGE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY MICHAEL SERRA NHA (ADMINISTRATOR)
(440) 428-6969
Entity
Organization
Contact information
Practice address
148 E MAIN ST, MADISON, OH 44057-3226
(440) 428-6969
(440) 428-6360
Mailing address
148 E MAIN ST, MADISON, OH 44057-3226
(440) 428-6969
(440) 428-6360
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2675
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0345442
—
OH
Enumeration date
12/15/2007
Last updated
06/19/2008
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