Provider Demographics
NPI:1922191519
Name:ROSS COUNTY BOARD OF MR/DD
Entity Type:Organization
Organization Name:ROSS COUNTY BOARD OF MR/DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-773-8044
Mailing Address - Street 1:11268 COUNTY ROAD 550
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-773-8044
Mailing Address - Fax:740-773-8052
Practice Address - Street 1:11268 COUNTY ROAD 550
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-773-8044
Practice Address - Fax:740-773-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7100014251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567628Medicaid