Provider Demographics
NPI:1457441826
Name:WYNN-REETH, INC.
Entity Type:Organization
Organization Name:WYNN-REETH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-639-2094
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-0785
Mailing Address - Country:US
Mailing Address - Phone:419-639-2094
Mailing Address - Fax:419-639-2099
Practice Address - Street 1:137 SOUTH BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-0785
Practice Address - Country:US
Practice Address - Phone:419-639-2094
Practice Address - Fax:419-639-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7200184251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0961544Medicaid
OH7200184OtherODMRDD PROVIDER NUMBER