NPIMap

Organization Active NPI

Phoenix Residential Centers, Inc.

Doing business as Lockwood Family Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Madison, OH
National Provider Identifier
1275873317
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
PHOENIX RESIDENTIAL CENTERS, INC.
Doing business as
Lockwood Family Home
Practice address
5278 Lockwood Rd
Madison, OH 44057-2313
Phone
(440) 428-0318
NPI assigned
Feb 27, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Mary Jo Jaskela
Title
Controller
Phone
(440) 428-9082

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

5278 Lockwood Rd
Madison, OH 44057-2313

Mailing address

1954 Hubbard Rd
P.O. Box 40
Madison, OH 44057-2172
Phone (440) 428-9082

Other names 1

  • Lockwood Family Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G667

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LOCKWOOD FAMILY HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 28, 2013
Last certification
Jul 16, 2024
Beds
8
Ownership / control type
Private (proprietary)
Facility address
5278 Lockwood Road
Madison, OH 44057

National Provider Directory

National Provider Directory
Tax ID family
Heisley Family Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1954 Hubbard Rd
Madison, OH 44057
Phone (440) 428-9082

NPI Registry JSON

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1275873317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 HUBBARD RD",
            "address_2": "P.O. BOX 40",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440572172",
            "telephone_number": "440-428-9082",
            "fax_number": "440-428-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5278 LOCKWOOD RD",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440572313",
            "telephone_number": "440-428-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RESIDENTIAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-27",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JASKELA",
        "authorized_official_first_name": "MARY JO",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "440-428-9082",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lockwood Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, OH

Sources for this page

Verify at the official NPI Registry.