Provider Demographics
NPI:1093929218
Name:RESDENTIAL HOME FOR THE DEVELOPMENTALLY DISABLED INC
Entity Type:Organization
Organization Name:RESDENTIAL HOME FOR THE DEVELOPMENTALLY DISABLED INC
Other - Org Name:RHDD INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-9778
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:PO BOX 997
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1302
Mailing Address - Country:US
Mailing Address - Phone:740-622-9778
Mailing Address - Fax:740-622-6640
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1302
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:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0845018251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1600128Medicaid