Madison Village Manor

NPI #1972786705 in Madison, Ohio

Provider Information

NPI Number: 1972786705
Entity Type: Organization
Organization Name: Madison Village Manor
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 15, 2007
Last Updated: Jun 19, 2008

Practice Location

Address: 148 E MAIN ST
City: Madison
State: Ohio
ZIP Code: 44057-3226
Phone: (440) 428-6969

Authorized Official

Name: MR. ANTHONY MICHAEL SERRA, NHA
Title: ADMINISTRATOR
Phone: (440) 428-6969

Specialties & Taxonomy Codes

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

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