Provider Demographics
NPI:1265224455
Name:MCNEILL, JOHNATHAN S
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:S
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19752 STATE ROUTE 31 STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VICTORY
Mailing Address - State:OH
Mailing Address - Zip Code:43340-9704
Mailing Address - Country:US
Mailing Address - Phone:614-329-0027
Mailing Address - Fax:
Practice Address - Street 1:19752 STATE ROUTE 31 STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VICTORY
Practice Address - State:OH
Practice Address - Zip Code:43340-9704
Practice Address - Country:US
Practice Address - Phone:614-329-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care