Provider Demographics
NPI:1053313254
Name:CENTRAL OHIO GROUP HOMES, INC.
Entity Type:Organization
Organization Name:CENTRAL OHIO GROUP HOMES, INC.
Other - Org Name:MORNING VIEW CARE CENTER GROUP HOME #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-614-0160
Mailing Address - Street 1:25000 COUNTRY CLUB BLVD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5344
Mailing Address - Country:US
Mailing Address - Phone:440-614-0160
Mailing Address - Fax:440-614-0168
Practice Address - Street 1:5510 COUNTY ROAD 25
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9346
Practice Address - Country:US
Practice Address - Phone:419-768-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5910134320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2417512Medicaid