Provider Demographics
NPI:1215795828
Name:LICKING COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:LICKING COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-644-0344
Mailing Address - Street 1:116 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2755
Mailing Address - Country:US
Mailing Address - Phone:740-644-0344
Mailing Address - Fax:
Practice Address - Street 1:116 N 22ND ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2755
Practice Address - Country:US
Practice Address - Phone:740-644-0344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LICKING COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management