Provider Demographics
NPI:1154318814
Name:MANSFIELD HEALTH CARE CENTER, LTD
Entity Type:Organization
Organization Name:MANSFIELD HEALTH CARE CENTER, LTD
Other - Org Name:TWIN OAKS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-526-0124
Mailing Address - Street 1:73 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-2830
Mailing Address - Country:US
Mailing Address - Phone:419-526-0124
Mailing Address - Fax:419-522-4391
Practice Address - Street 1:73 MADISON RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2830
Practice Address - Country:US
Practice Address - Phone:419-526-0124
Practice Address - Fax:419-522-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-28
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5533314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706168Medicaid
OH365866Medicare Oscar/Certification
OH2706168Medicaid