Provider Demographics
NPI:1275686602
Name:TIFFIN DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:TIFFIN DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCQUISTION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-1450
Mailing Address - Street 1:600 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1173
Mailing Address - Country:US
Mailing Address - Phone:419-447-1450
Mailing Address - Fax:419-448-6506
Practice Address - Street 1:600 N RIVER RD
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1173
Practice Address - Country:US
Practice Address - Phone:419-447-1450
Practice Address - Fax:419-448-6506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OHIO DEPT. OF DD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36G588315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2396107Medicaid
OH9338745Medicare PIN