Organization
LOGAN COUNTY BOARD OF MRDD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH F MANCUSO PH.D. (SUPERINTENDENT)
(937) 292-3009
Entity
Organization
Contact information
Practice address
1851 STATE ROUTE 47 W, BELLEFONTAINE, OH 43311-9328
(937) 592-0015
(937) 592-5615
Mailing address
1851 STATE ROUTE 47 W, BELLEFONTAINE, OH 43311-9328
(937) 592-0015
(937) 592-5615
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4600015
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0776165
—
OH
Enumeration date
03/29/2007
Last updated
08/22/2020
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