Provider Demographics
NPI:1477670982
Name:ASHTABULA COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:ASHTABULA COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-224-2155
Mailing Address - Street 1:2505 SOUTH RIDGE ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4493
Mailing Address - Country:US
Mailing Address - Phone:440-224-2155
Mailing Address - Fax:440-224-0678
Practice Address - Street 1:2505 SOUTH RIDGE ROAD EAST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4493
Practice Address - Country:US
Practice Address - Phone:440-224-2155
Practice Address - Fax:440-224-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2556372Medicaid