NPIMap

Organization Active NPI

Madison Village Manor

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Madison, OH
National Provider Identifier
1972786705
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
2675 Issued in OH
Legal business name
MADISON VILLAGE MANOR
Practice address
148 E Main St
Madison, OH 44057-3226
Phone
(440) 428-6969
Fax
(440) 428-6360
NPI assigned
Dec 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Mr. Anthony Michael Serra, NHA
Title
Administrator
Phone
(440) 428-6969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 2675 OH Primary

Addresses

Primary practice location

148 E Main St
Madison, OH 44057-3226

Mailing address

148 E Main St
Madison, OH 44057-3226
Phone (440) 428-6969

Other identifiers 1

IdentifierTypeStateIssuer
0345442MedicaidOH

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 36G147

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
MADISON VILLAGE MANOR
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 12, 1983
Last certification
Nov 13, 2025
Beds
8
Ownership / control type
Private (proprietary)
Facility address
148 E Main Street
Madison, OH 44057

National Provider Directory

National Provider Directory
Tax ID family
Madison Village Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

148 E Main St
Madison, OH 44057
Phone (440) 428-6969

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1197676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1972786705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 E MAIN ST",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440573226",
            "telephone_number": "440-428-6969",
            "fax_number": "440-428-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 E MAIN ST",
            "city": "MADISON",
            "state": "OH",
            "postal_code": "440573226",
            "telephone_number": "440-428-6969",
            "fax_number": "440-428-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON VILLAGE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-15",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "SERRA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "440-428-6969",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "2675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0345442",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, OH

Sources for this page

Verify at the official NPI Registry.