Provider Demographics
NPI:1710379292
Name:THE COUNCIL ON DEVELOPMENTAL DISABILITIES, INC.
Entity Type:Organization
Organization Name:THE COUNCIL ON DEVELOPMENTAL DISABILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORNWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-584-1239
Mailing Address - Street 1:1151 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3101
Mailing Address - Country:US
Mailing Address - Phone:502-584-1239
Mailing Address - Fax:
Practice Address - Street 1:1151 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3101
Practice Address - Country:US
Practice Address - Phone:502-584-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management