Provider Demographics
NPI:1497959605
Name:NORTHWEST OHIO DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:NORTHWEST OHIO DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIERHOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1419-385-0231
Mailing Address - Street 1:1101 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2704
Mailing Address - Country:US
Mailing Address - Phone:419-385-0231
Mailing Address - Fax:419-382-0719
Practice Address - Street 1:1101 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2704
Practice Address - Country:US
Practice Address - Phone:419-385-0231
Practice Address - Fax:419-382-0719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OHIO - DEPARTMENT OF MRDD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411287Medicaid
OH9382412Medicare PIN