Provider Demographics
NPI:1154415032
Name:CLARK COUNTY EDUCATIONAL SERVICE CENTER
Entity type:Organization
Organization Name:CLARK COUNTY EDUCATIONAL SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:CALLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-325-7671
Mailing Address - Street 1:30 WARDER ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2580
Mailing Address - Country:US
Mailing Address - Phone:937-325-7671
Mailing Address - Fax:937-325-9915
Practice Address - Street 1:30 WARDER ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2580
Practice Address - Country:US
Practice Address - Phone:937-325-7671
Practice Address - Fax:937-325-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0902232Medicaid