Organization
JACKSON CBMRDD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEATRICE KAYE MICHAEL (SUPERINTENDENT)
(740) 286-6491
Entity
Organization
Contact information
Practice address
202 S PENNSYLVANIA AVE, WELLSTON, OH 45692-1719
(740) 286-6491
Mailing address
202 S PENNSYLVANIA AVE, WELLSTON, OH 45692-1719
(740) 286-6491
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4000011
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0801207
—
OH
Enumeration date
03/29/2007
Last updated
08/22/2020
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