Provider Demographics
NPI:1235747320
Name:OTTAWA VALLEY CENTER, INC.
Entity Type:Organization
Organization Name:OTTAWA VALLEY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-999-5260
Mailing Address - Street 1:1325 S SERIFF RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2818
Mailing Address - Country:US
Mailing Address - Phone:419-999-5260
Mailing Address - Fax:
Practice Address - Street 1:1325 S SERIFF RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2818
Practice Address - Country:US
Practice Address - Phone:419-999-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2001943Medicaid
OH0200197OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES