Organization
CLARK COUNTY
Active
Organization
CLARK COUNTY
Active
Other names
CLARK COUNTY BOARD OF MR/DD YELLOW ICF/MR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVI R SHANKAR (COMPTROLLER)
(937) 328-4626
Entity
Organization
Contact information
Practice address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
(937) 328-4625
Mailing address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
(937) 328-4625
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2814576
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2815476
—
OH
Enumeration date
06/04/2008
Last updated
06/04/2008
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