Provider Demographics
NPI:1306068085
Name:DELAWARE COUNTY BOARD OF MENTAL RETARDATION & DEVELOPMENTAL DISABILITI
Entity type:Organization
Organization Name:DELAWARE COUNTY BOARD OF MENTAL RETARDATION & DEVELOPMENTAL DISABILITI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-201-3600
Mailing Address - Street 1:7991 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9611
Mailing Address - Country:US
Mailing Address - Phone:740-201-3600
Mailing Address - Fax:
Practice Address - Street 1:7991 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9611
Practice Address - Country:US
Practice Address - Phone:740-201-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0873149251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0873149Medicaid