Provider Demographics
NPI:1356442024
Name:ERIE COUNTY BOARD OF MR/DD
Entity Type:Organization
Organization Name:ERIE COUNTY BOARD OF MR/DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:PLASSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-626-0208
Mailing Address - Street 1:4405 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6026
Mailing Address - Country:US
Mailing Address - Phone:419-626-0208
Mailing Address - Fax:419-621-3968
Practice Address - Street 1:4405 GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-6026
Practice Address - Country:US
Practice Address - Phone:419-626-0208
Practice Address - Fax:419-621-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2200013251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services