Provider Demographics
NPI:1699891978
Name:PREBLE COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:PREBLE COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-404-6213
Mailing Address - Street 1:200 EATON LEWISBURG RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-1192
Mailing Address - Country:US
Mailing Address - Phone:937-404-6213
Mailing Address - Fax:937-332-1492
Practice Address - Street 1:200 EATON LEWISBURG RD STE 201
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1192
Practice Address - Country:US
Practice Address - Phone:937-404-6213
Practice Address - Fax:937-332-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0773104251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773104Medicaid