Provider Demographics
NPI:1013131614
Name:FAYETTE COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:FAYETTE COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-335-7453
Mailing Address - Street 1:1330 ROBINSON RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9201
Mailing Address - Country:US
Mailing Address - Phone:740-335-7453
Mailing Address - Fax:740-335-2185
Practice Address - Street 1:1330 ROBINSON RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9201
Practice Address - Country:US
Practice Address - Phone:740-335-7453
Practice Address - Fax:740-335-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2400011Medicaid