Organization
DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
D MICHAEL SNOW (SUPERINTENDENT)
(614) 272-0509
Entity
Organization
Contact information
Practice address
1601 W BROAD ST, COLUMBUS, OH 43222-1054
(614) 272-0509
(614) 272-1054
Mailing address
30 E BROAD ST, COLUMBUS, OH 43215-3414
(614) 466-1970
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
2514097
OH
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2514097
OH
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
2514097
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2438080
—
OH
Enumeration date
01/04/2007
Last updated
12/05/2008
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