Provider Demographics
NPI:1417071051
Name:PIKE COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:PIKE COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FYFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-289-1681
Mailing Address - Street 1:10 AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9108
Mailing Address - Country:US
Mailing Address - Phone:740-289-1681
Mailing Address - Fax:740-289-8923
Practice Address - Street 1:10 AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9108
Practice Address - Country:US
Practice Address - Phone:740-289-1681
Practice Address - Fax:740-289-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884584Medicaid