Provider Demographics
NPI:1386360022
Name:PIKE CO BOARD OF DD
Entity type:Organization
Organization Name:PIKE CO BOARD OF DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-947-8470
Mailing Address - Street 1:330 E. NORTH ST.
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690
Mailing Address - Country:US
Mailing Address - Phone:740-947-8470
Mailing Address - Fax:740-947-8472
Practice Address - Street 1:330 E. NORTH ST.
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690
Practice Address - Country:US
Practice Address - Phone:740-947-8470
Practice Address - Fax:740-947-8472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIKE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6600011OtherDEPT. OF DEVELOPMENTAL DISABILITIES
OH2567593Medicaid