NPIMap

Organization Active NPI

Oak Grove Manor MRDD

  • Intellectual Disabilities Intermediate Care Facility
  • Mansfield, OH
National Provider Identifier
1285762450
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
1783N Issued in OH
Legal business name
OAK GROVE MANOR MRDD
Practice address
1670 Crider Rd
Mansfield, OH 44903-9268
Phone
(614) 459-2482
Fax
(614) 459-2641
NPI assigned
Mar 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Oscar G Aleman
Title
Controller
Phone
(614) 459-2482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1783N OH Primary

Addresses

Primary practice location

1670 Crider Rd
Mansfield, OH 44903-9268

Mailing address

1661 Old Henderson Rd
Columbus, OH 43220-3644
Phone (614) 459-2482

Other identifiers 1

IdentifierTypeStateIssuer
2561464MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Autumn Court4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285762450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 OLD HENDERSON RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432203644",
            "telephone_number": "614-459-2482",
            "fax_number": "614-459-2641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 CRIDER RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449039268",
            "telephone_number": "614-459-2482",
            "fax_number": "614-459-2641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE MANOR MRDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALEMAN",
        "authorized_official_first_name": "OSCAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "614-459-2482"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "1783N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2561464",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mansfield, OH

Sources for this page

  • 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.