Provider Demographics
NPI:1740357888
Name:GUERNSEY RESIDENTIAL, INC.
Entity type:Organization
Organization Name:GUERNSEY RESIDENTIAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-439-4271
Mailing Address - Street 1:627 STEUBENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2241
Mailing Address - Country:US
Mailing Address - Phone:740-439-4271
Mailing Address - Fax:740-439-2866
Practice Address - Street 1:627 STEUBENVILLE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2241
Practice Address - Country:US
Practice Address - Phone:740-439-4271
Practice Address - Fax:740-439-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3010093320900000X
OH3010164320900000X
OH3010155320900000X
OH3010280320900000X
OH3010271320900000X
OH3010299320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3000237Medicaid