Provider Demographics
NPI:1790901734
Name:UNION COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:UNION COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT FISCAL
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-645-6733
Mailing Address - Street 1:1280 CHARLES LN
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9797
Mailing Address - Country:US
Mailing Address - Phone:937-645-6733
Mailing Address - Fax:937-642-8427
Practice Address - Street 1:1280 CHARLES LN
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9797
Practice Address - Country:US
Practice Address - Phone:937-645-6733
Practice Address - Fax:937-642-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0899130Medicaid