Organization
CHAMPAIGN COUNTY BOARD MRDD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH WAGNER (BUSINESS MANAGER)
(937) 653-5217
Entity
Organization
Contact information
Practice address
1250 EAST STATE ROUTE 36, URBANA, OH 43044
(937) 653-5217
(937) 653-7516
Mailing address
1250 EAST STATE ROUTE 36, P O BOX 829, URBANA, OH 43044
(937) 653-5217
(937) 653-7516
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
773140
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
773140
—
OH
Enumeration date
04/09/2007
Last updated
08/22/2020
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