Provider Demographics
NPI:1457485104
Name:HENRY COUNTY BOARD OF DD
Entity Type:Organization
Organization Name:HENRY COUNTY BOARD OF DD
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:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-599-2892
Mailing Address - Street 1:135 E MAUMEE AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-2020
Mailing Address - Country:US
Mailing Address - Phone:419-599-2892
Mailing Address - Fax:491-599-5828
Practice Address - Street 1:135 E MAUMEE AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-2020
Practice Address - Country:US
Practice Address - Phone:419-599-2892
Practice Address - Fax:491-599-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3500018251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services