Provider Demographics
NPI:1003816596
Name:GALLIA COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:GALLIA COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-367-7371
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:OH
Mailing Address - Zip Code:45620-9001
Mailing Address - Country:US
Mailing Address - Phone:740-367-7371
Mailing Address - Fax:740-367-0290
Practice Address - Street 1:8323 STATE ROUTE 7 NORTH
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:OH
Practice Address - Zip Code:45620-0014
Practice Address - Country:US
Practice Address - Phone:740-367-7371
Practice Address - Fax:740-367-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH070615251B00000X, 251C00000X, 347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700018Medicaid