Taej Residential Care, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1457R Issued in OH

Legal business name

TAEJ RESIDENTIAL CARE, LLC

Practice address

111 S Diamond St
Mansfield, OH 44902-7510

Phone

(419) 522-4450

Fax

(419) 522-4552

NPI assigned

Dec 11, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael F Jedra, LNHA

Title

Administrator

Phone

(419) 522-4450

Specialties & licenses 1

Addresses

Other names 1

• Diamond View RCF Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1679756837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S DIAMOND ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449027510",
            "telephone_number": "419-522-4450",
            "fax_number": "419-522-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S DIAMOND ST",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449027510",
            "telephone_number": "419-522-4450",
            "fax_number": "419-522-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAEJ RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "JEDRA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "419-522-4450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "1457R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diamond View RCF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marquis Levar Sykes
• T L Sazdanoff DC Inc
• Harout Michael Tabrizi
• Lorrie Lee Tackett
• Margaret Tackett, LSW
• Taking Root Farms
• Gubert Lee Tan, MD
• Montana Tanner
• Sierrah Taska
• Geron Tate

• Assisted Living Facility in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.