Provider Demographics
NPI:1619038239
Name:WARRENSVILLE DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:WARRENSVILLE DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGREGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-464-7400
Mailing Address - Street 1:4325 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4884
Mailing Address - Country:US
Mailing Address - Phone:216-464-7400
Mailing Address - Fax:216-464-4755
Practice Address - Street 1:4325 GREEN RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44128-4884
Practice Address - Country:US
Practice Address - Phone:216-464-7400
Practice Address - Fax:216-464-4755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OHIO DEPARTMENT OF MRDD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1812033315P00000X
OH1812042315P00000X
OH1812177315P00000X
OH1812051315P00000X
OH1812186315P00000X
OH1812060315P00000X
OH1812088315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338746Medicare PIN