Provider Demographics
NPI:1629193420
Name:PAULDING COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:PAULDING COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-399-4800
Mailing Address - Street 1:900 FAIRGROUND DR
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9261
Mailing Address - Country:US
Mailing Address - Phone:419-399-4800
Mailing Address - Fax:419-399-4820
Practice Address - Street 1:900 FAIRGROUND DR
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9261
Practice Address - Country:US
Practice Address - Phone:419-399-4800
Practice Address - Fax:419-399-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6300014Medicaid