Provider Demographics
NPI:1124051842
Name:DDC CLINIC FOR SPECIAL NEEDS CHILDREN
Entity type:Organization
Organization Name:DDC CLINIC FOR SPECIAL NEEDS CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-632-1668
Mailing Address - Street 1:14567 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9499
Mailing Address - Country:US
Mailing Address - Phone:440-632-1668
Mailing Address - Fax:440-632-1697
Practice Address - Street 1:14567 MADISON RD
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9499
Practice Address - Country:US
Practice Address - Phone:440-632-1668
Practice Address - Fax:440-632-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH81033261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2323980Medicaid