Organization
CLARK COUNTY
Active
Other names
CLARK COUNTY BOARD OF MR/DD UNIT C ICF/MR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVI R SHANKAR (COMPTROLLER)
(937) 328-4626
Entity
Organization
Contact information
Practice address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
Mailing address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0850155
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0850155
—
OH
Enumeration date
04/17/2008
Last updated
04/17/2008
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