Organization
CLARK COUNTY
Active
Other names
CLARK COUNTY BOARD OF MR/DD
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAVI SHANKAR (COMPTROLLER)
(937) 328-2675
Entity
Organization
Contact information
Practice address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
Mailing address
2527 KENTON ST, SPRINGFIELD, OH 45505-3352
(937) 328-2675
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
2568163
OH
251C00000X
Developmentally Disabled Services Day Training Agency
2566361
OH
251S00000X
Community/Behavioral Health Agency
2566361
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0345184
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0531679
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0559613
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0850155
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
0888848
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2082642
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2566361
—
OH
05
—
2568163
—
OH
Enumeration date
08/05/2007
Last updated
08/05/2007
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