Madison Village Manor, INC

NPI #1154504983 in Madison, Ohio

Provider Information

NPI Number: 1154504983
Entity Type: Organization
Organization Name: Madison Village Manor, INC
Subpart: Yes (part of a larger organization)
Parent Organization: MADISON VILLAGE MANOR, INC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 15, 2007
Last Updated: Dec 15, 2007

Practice Location

Address: 731 N LAKE ST
City: Madison
State: Ohio
ZIP Code: 44057-3152
Phone: (440) 428-1519

Authorized Official

Name: MR. ANTHONY MICHAEL SERRA, NHA
Title: ADMINISTRATOR
Phone: (440) 428-1519

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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