Provider Demographics
NPI:1609968213
Name:MEDINA COUNTY BOARD OF MR/DD
Entity type:Organization
Organization Name:MEDINA COUNTY BOARD OF MR/DD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:COERVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-725-7751
Mailing Address - Street 1:4691 WINDFALL RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8705
Mailing Address - Country:US
Mailing Address - Phone:330-725-7751
Mailing Address - Fax:330-722-4854
Practice Address - Street 1:4691 WINDFALL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8705
Practice Address - Country:US
Practice Address - Phone:330-725-7751
Practice Address - Fax:330-722-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
Not Answered344600000XTransportation ServicesTaxiGroup - Multi-Specialty
Not Answered347B00000XTransportation ServicesBusGroup - Multi-Specialty
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671312Medicaid
OH2567306Medicaid