Provider Demographics
NPI:1588788210
Name:AUGLAIZE COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:AUGLAIZE COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-629-2419
Mailing Address - Street 1:20 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1165
Mailing Address - Country:US
Mailing Address - Phone:419-629-2419
Mailing Address - Fax:419-629-3806
Practice Address - Street 1:20 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-1165
Practice Address - Country:US
Practice Address - Phone:419-629-2419
Practice Address - Fax:419-629-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered347E00000XTransportation ServicesTransportation Broker