Provider Demographics
NPI:1871006296
Name:DEVELOPMENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DEVELOPMENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-578-1185
Mailing Address - Street 1:1555 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2003
Mailing Address - Country:US
Mailing Address - Phone:614-578-1165
Mailing Address - Fax:
Practice Address - Street 1:1555 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2003
Practice Address - Country:US
Practice Address - Phone:614-578-1165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5339261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities