Mansfield Group Home, LTD

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

15636 Issued in OH

Legal business name

MANSFIELD GROUP HOME, LTD

Practice address

245 W 4TH St
Mansfield, OH 44903-1704

Phone

(419) 524-2335

Fax

(419) 522-4391

NPI assigned

Sep 28, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tracy R Robertson

Title

Corp. Office Executive Assistant

Phone

(419) 526-0124

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CHENITA GROUP HOME Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063409738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 W 4TH ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449031704",
            "telephone_number": "419-524-2335",
            "fax_number": "419-522-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 W 4TH ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449031704",
            "telephone_number": "419-524-2335",
            "fax_number": "419-522-4391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANSFIELD GROUP HOME, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CORP. OFFICE EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "419-526-0124",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "15636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2076131",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHENITA GROUP HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mansfield Care Center Opco LLC
• Mansfield City Schools
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• Mansfield Endodontics, LTD.
• Mansfield Family Practice
• Mansfield Health Care Center, LTD
• Mansfield Imaging Center LLC
• Mansfield Internal Medicine, Inc
• Mansfield Living Center, LTD
• Mansfield Memorial Homes, Inc

• Intellectual Disabilities Intermediate Care Facility in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Intellectual Disabilities Intermediate Care Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.