Provider Demographics
NPI:1508866369
Name:ASHLAND COUNTY BOARD MRDD
Entity Type:Organization
Organization Name:ASHLAND COUNTY BOARD MRDD
Other - Org Name:DALE ROY
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-289-0470
Mailing Address - Street 1:1256 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4139
Mailing Address - Country:US
Mailing Address - Phone:419-289-0470
Mailing Address - Fax:419-281-2820
Practice Address - Street 1:1256 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4139
Practice Address - Country:US
Practice Address - Phone:419-289-0470
Practice Address - Fax:419-281-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
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
OH0300016Medicaid