1194852749 NPI number — BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE

Table of content: (NPI 1194852749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194852749 NPI number — BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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NPI Number Information

NPI Number:
1194852749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 WEST STATE STREET
Provider Second Line Business Mailing Address:
BUILDING A, SUITE 2
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45121-9098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-378-4891
Provider Business Mailing Address Fax Number:
937-378-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 W STATE ST
Provider Second Line Business Practice Location Address:
BUILDING A, SUITE 2
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45121-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-378-4891
Provider Business Practice Location Address Fax Number:
937-378-3585
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRADFORD
Authorized Official First Name:
LENA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
937-378-4891

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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