Provider Demographics
NPI:1033658984
Name:RESIDENTIAL HOME FOR THE DEVELOPMENTALLY DISABLED INC
Entity Type:Organization
Organization Name:RESIDENTIAL HOME FOR THE DEVELOPMENTALLY DISABLED INC
Other - Org Name:RHDD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-9778
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-0997
Mailing Address - Country:US
Mailing Address - Phone:740-622-9778
Mailing Address - Fax:740-622-6640
Practice Address - Street 1:1517 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1436
Practice Address - Country:US
Practice Address - Phone:740-622-9778
Practice Address - Fax:740-622-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)