Organization
LICKING COUNTY BOARD OF MRDD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY SMITH (DIRECTOR OF FINANCE)
(740) 349-6588
Entity
Organization
Contact information
Practice address
65 W CHURCH ST, NEWARK, OH 43055-5013
(740) 349-6588
(740) 349-6595
Mailing address
65 W CHURCH ST, NEWARK, OH 43055-5013
(740) 349-6588
(740) 349-6595
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
4500016
OH
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4500016
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0773051
—
OH
Enumeration date
02/23/2007
Last updated
09/11/2025
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