Provider Demographics
NPI:1053865568
Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABILITIES
Entity Type:Organization
Organization Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABILITIES
Other - Org Name:ASSOCIATION FOR THE DEVELOPMENTALLY DISABLED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-840-6851
Mailing Address - Street 1:9772 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9128
Mailing Address - Country:US
Mailing Address - Phone:330-274-2272
Mailing Address - Fax:
Practice Address - Street 1:2433 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-9328
Practice Address - Country:US
Practice Address - Phone:330-274-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0575542Medicaid