Provider Demographics
NPI:1063667103
Name:WOOD COUNTY BOARD OF MR/DD
Entity Type:Organization
Organization Name:WOOD COUNTY BOARD OF MR/DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FISCAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-352-5115
Mailing Address - Street 1:11160 E GYPSY LANE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9564
Mailing Address - Country:US
Mailing Address - Phone:419-352-5115
Mailing Address - Fax:419-354-4376
Practice Address - Street 1:1009 KLOTZ RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4820
Practice Address - Country:US
Practice Address - Phone:419-352-5115
Practice Address - Fax:419-354-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0933646Medicaid