Provider Demographics
NPI:1104949734
Name:WAYNE COUNTY BD OF MENTAL RETARDATION AND DEVELOPMENT DISABILITIES
Entity type:Organization
Organization Name:WAYNE COUNTY BD OF MENTAL RETARDATION AND DEVELOPMENT DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-345-6016
Mailing Address - Street 1:266 OLDMAN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8540
Mailing Address - Country:US
Mailing Address - Phone:330-345-6016
Mailing Address - Fax:330-345-7210
Practice Address - Street 1:266 OLDMAN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8540
Practice Address - Country:US
Practice Address - Phone:330-345-6016
Practice Address - Fax:330-345-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8500018251B00000X, 251C00000X, 347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered347B00000XTransportation ServicesBus