Provider Demographics
NPI:1518081231
Name:PERRY COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:PERRY COUNTY BOARD OF MRDD
Other - Org Name:PERRY COUNTY BOARD OF DD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAID SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-343-7139
Mailing Address - Street 1:601 SENIOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1575
Mailing Address - Country:US
Mailing Address - Phone:740-342-7139
Mailing Address - Fax:740-342-1081
Practice Address - Street 1:601 SENIOR DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1575
Practice Address - Country:US
Practice Address - Phone:740-342-7139
Practice Address - Fax:740-342-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0780007251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0780007Medicaid