Organization
DEFIANCE COUNTY BOARD OF DD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET MACK (BUSINESS MANAGER)
(419) 782-6621
Entity
Organization
Contact information
Practice address
195 ISLAND PARK AVE, DEFIANCE, OH 43512-2561
(419) 782-6621
Mailing address
195 ISLAND PARK AVE, DEFIANCE, OH 43512-2561
(419) 782-6621
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0790694
—
OH
05
—
2556416
—
OH
05
—
2568458
—
OH
Enumeration date
09/13/2016
Last updated
11/02/2016
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