Provider Demographics
NPI:1194852749
Name:BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE
Entity Type:Organization
Organization Name:BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-378-4891
Mailing Address - Street 1:325 WEST STATE STREET
Mailing Address - Street 2:BUILDING A, SUITE 2
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-9098
Mailing Address - Country:US
Mailing Address - Phone:937-378-4891
Mailing Address - Fax:937-378-3585
Practice Address - Street 1:325 W STATE ST
Practice Address - Street 2:BUILDING A, SUITE 2
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1229
Practice Address - Country:US
Practice Address - Phone:937-378-4891
Practice Address - Fax:937-378-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities