Provider Demographics
NPI:1497849954
Name:SANDUSKY COUNTY BOARD OF MR/DD
Entity Type:Organization
Organization Name:SANDUSKY COUNTY BOARD OF MR/DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-332-9296
Mailing Address - Street 1:1001 CASTALIA STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420
Mailing Address - Country:US
Mailing Address - Phone:419-332-9296
Mailing Address - Fax:419-332-9571
Practice Address - Street 1:1001 CASTALIA STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420
Practice Address - Country:US
Practice Address - Phone:419-332-9296
Practice Address - Fax:419-332-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
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
OH7200013Medicaid