Provider Demographics
NPI:1992869069
Name:MOUNT VERNON DEVELOPMENTAL CENTER
Entity type:Organization
Organization Name:MOUNT VERNON DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNST
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-393-6231
Mailing Address - Street 1:1250 VERNONVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1447
Mailing Address - Country:US
Mailing Address - Phone:740-393-6231
Mailing Address - Fax:740-393-6266
Practice Address - Street 1:1250 VERNONVIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1447
Practice Address - Country:US
Practice Address - Phone:740-393-6231
Practice Address - Fax:740-393-6266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411732Medicaid
OH2411732Medicaid