Provider Demographics
NPI:1710006614
Name:MIAMI COUNTY BOARD MRDD
Entity Type:Organization
Organization Name:MIAMI COUNTY BOARD MRDD
Other - Org Name:RIVERSIDE OF MIAMI COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-339-8313
Mailing Address - Street 1:1625 TROY SIDNEY RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9794
Mailing Address - Country:US
Mailing Address - Phone:937-339-8313
Mailing Address - Fax:937-335-6907
Practice Address - Street 1:1625 TROY SIDNEY RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9794
Practice Address - Country:US
Practice Address - Phone:937-339-8313
Practice Address - Fax:937-335-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
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
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0923291Medicaid