Phoenix Residential Centers, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

PHOENIX RESIDENTIAL CENTERS, INC.

Doing business as

Meredith Lane Family Home

Practice address

12345 Meredith LN
Painesville, OH 44077-9246

Phone

(440) 428-9082

NPI assigned

Jan 9, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Mary Jo Jaskela

Title

Controller

Phone

(440) 428-9082

Specialties & licenses 1

Addresses

Other names 1

• Meredith Lane Family Home Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G687

Legal name

MEREDITH LANE FAMILY HOME

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jul 27, 2015

Last certification

Apr 2, 2024

Beds

5

Ownership / control type

Private (proprietary)

Facility address

12345 Meredith Lane
Painesville, OH 44077

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.

• Phoenix Residential Centers, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Madison, OH
  • NPI 1275873317
  NPD tax ID
• Phoenix Residential Centers, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mentor, OH
  • NPI 1821429267
  NPD tax ID

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420761600000",
    "number": "1629467972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 HUBBARD RD",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440572172",
            "telephone_number": "440-428-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12345 MEREDITH LN",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "440779246",
            "telephone_number": "440-428-9082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RESIDENTIAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-09",
        "last_updated": "2015-01-09",
        "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": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meredith Lane Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Pham, MA, CCC-SLP
• Coleen T Phelps, LPN
• Lynda Phelps
• Jessica Phillipp
• Julie Phillips, ATC
• Physicians Plus Inc
• Stephanie Pichler, DMD
• Pieces of You Home Therapy Services
• Michelle Claire Pierce, RN
• Pinnacle Treatment Centers Oh-Xix, LLC

• Intellectual Disabilities Intermediate Care Facility in Painesville, OH
• Providers in Painesville, 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 Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.