Provider Demographics
NPI:1073638458
Name:YOUNGSTOWN DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:YOUNGSTOWN DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-544-2231
Mailing Address - Street 1:4891 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9411
Mailing Address - Country:US
Mailing Address - Phone:330-544-2231
Mailing Address - Fax:330-544-3519
Practice Address - Street 1:4891 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9411
Practice Address - Country:US
Practice Address - Phone:330-544-2231
Practice Address - Fax:330-544-3519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OHIO DEPT. OF MR/DD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36G589315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2396134Medicaid
OH9333786Medicare UPIN