Provider Demographics
NPI:1912179755
Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES
Entity Type:Organization
Organization Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-840-6851
Mailing Address - Street 1:9772 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9128
Mailing Address - Country:US
Mailing Address - Phone:330-274-2272
Mailing Address - Fax:
Practice Address - Street 1:9772 DIAGONAL ROAD
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255
Practice Address - Country:US
Practice Address - Phone:330-274-2272
Practice Address - Fax:330-732-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0729322315P00000X
OH315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0729322Medicaid