Provider Demographics
NPI:1356597835
Name:ONTARIO COMMONS
Entity type:Organization
Organization Name:ONTARIO COMMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRANCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-529-6447
Mailing Address - Street 1:2124 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3807
Mailing Address - Country:US
Mailing Address - Phone:419-529-6447
Mailing Address - Fax:419-529-2108
Practice Address - Street 1:2124 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3807
Practice Address - Country:US
Practice Address - Phone:419-529-6447
Practice Address - Fax:419-529-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2165R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility