Provider Demographics
NPI:1790263184
Name:RICHLAND COUNTY BOARD OF DD
Entity Type:Organization
Organization Name:RICHLAND COUNTY BOARD OF DD
Other - Org Name:HARDING AVENUE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA ACCOUNTING
Authorized Official - Phone:419-774-4200
Mailing Address - Street 1:314 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-8623
Mailing Address - Country:US
Mailing Address - Phone:419-774-7836
Mailing Address - Fax:
Practice Address - Street 1:1440 HARDING AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2756
Practice Address - Country:US
Practice Address - Phone:419-774-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHLAND COUNTY BOARD OF DD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36G576Medicaid