NPIMap

Organization Active NPI

Phoenix Residential Centers, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mentor, OH
National Provider Identifier
1821429267
Registry record updated Dec 11, 2013
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
Heisley Family Home
Practice address
5422 W Heisley Rd
Mentor, OH 44060-1751
Phone
(440) 352-1105
NPI assigned
Dec 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

5422 W Heisley Rd
Mentor, OH 44060-1751

Mailing address

PO Box 40
Madison, OH 44057-0040
Phone (440) 428-9082

Other names 1

  • Heisley Family Home Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1821429267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440570040",
            "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": "5422 W HEISLEY RD",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440601751",
            "telephone_number": "440-352-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RESIDENTIAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "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": "Heisley Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mentor, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.