Provider Demographics
NPI:1922150200
Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABILITIES
Entity Type:Organization
Organization Name:HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
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:614-486-4361
Mailing Address - Fax:614-486-3191
Practice Address - Street 1:769 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2821
Practice Address - Country:US
Practice Address - Phone:614-486-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0567855Medicaid
OH0550210Medicaid
OH0557697Medicaid
OH2500672Medicaid
OH0575542Medicaid
OH0508025Medicaid
OH0575533Medicaid
OH2561900Medicaid
OH0512663Medicaid
OH2522229Medicaid
OH36G187Medicare UPIN
OH2561900Medicaid
OH36G612Medicare ID - Type Unspecified
OH0512663Medicaid
OH36G604Medicare ID - Type Unspecified
OH36G126Medicare ID - Type Unspecified
OH36G186Medicare ID - Type Unspecified
OH2500672Medicaid
OH2522229Medicaid
OH0575542Medicaid