Provider Demographics
NPI:1548946122
Name:MANSA LLC
Entity type:Organization
Organization Name:MANSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-465-9375
Mailing Address - Street 1:162 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1901
Mailing Address - Country:US
Mailing Address - Phone:440-465-9375
Mailing Address - Fax:
Practice Address - Street 1:162 HICKORY LN
Practice Address - Street 2:
Practice Address - City:MORELAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44022-1901
Practice Address - Country:US
Practice Address - Phone:440-465-9375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty