Provider Demographics
NPI:1275756967
Name:MUSKINGUM RESIDENTIALS, INC.
Entity Type:Organization
Organization Name:MUSKINGUM RESIDENTIALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-453-5350
Mailing Address - Street 1:PO BOX 2415
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-2415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2617
Practice Address - Country:US
Practice Address - Phone:740-453-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2000766Medicaid