Provider Demographics
NPI:1023003977
Name:ADAMS COUNTY BOARD OF MENTAL RETARDATION & DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:ADAMS COUNTY BOARD OF MENTAL RETARDATION & DEVELOPMENTAL DISABILITIES
Other - Org Name:OLIVER SCHOOL , VENTURE PRODUCTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FISCAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-544-1644
Mailing Address - Street 1:3964 WHEAT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9457
Mailing Address - Country:US
Mailing Address - Phone:937-544-1644
Mailing Address - Fax:937-544-2223
Practice Address - Street 1:3964 WHEAT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9457
Practice Address - Country:US
Practice Address - Phone:937-544-1644
Practice Address - Fax:937-544-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0100018251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH810395Medicaid