Provider Demographics
NPI:1922123116
Name:VAN WERT COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:VAN WERT COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-1514
Mailing Address - Street 1:525 AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1370
Mailing Address - Country:US
Mailing Address - Phone:419-238-1514
Mailing Address - Fax:
Practice Address - Street 1:525 AUGUSTINE DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1370
Practice Address - Country:US
Practice Address - Phone:419-238-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0880015251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8100012Medicaid