Provider Demographics
NPI:1396873592
Name:PICKAWAY COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:PICKAWAY COUNTY BOARD OF MRDD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-248-8579
Mailing Address - Street 1:200 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1724
Mailing Address - Country:US
Mailing Address - Phone:740-477-3353
Mailing Address - Fax:740-477-6772
Practice Address - Street 1:200 E HIGH ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1724
Practice Address - Country:US
Practice Address - Phone:740-248-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0801990Medicaid