Provider Demographics
NPI:1194268433
Name:GEAUGA COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:GEAUGA COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:RICE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:440-729-9406
Mailing Address - Street 1:8200 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3550
Mailing Address - Country:US
Mailing Address - Phone:440-729-9406
Mailing Address - Fax:440-729-0131
Practice Address - Street 1:8200 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-3550
Practice Address - Country:US
Practice Address - Phone:440-729-9406
Practice Address - Fax:440-729-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2567744251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567744Medicaid