Provider Demographics
NPI:1750406211
Name:TUSCARAWAS COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:TUSCARAWAS COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-339-9779
Mailing Address - Street 1:610 COMMERCIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-9365
Mailing Address - Country:US
Mailing Address - Phone:330-308-7173
Mailing Address - Fax:330-339-7539
Practice Address - Street 1:610 COMMERCIAL AVE SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-9365
Practice Address - Country:US
Practice Address - Phone:330-308-7173
Practice Address - Fax:330-339-7539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUSCARAWAS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568949Medicaid
OH7900016OtherOHIO DEPT. OF DEVELOPMENTAL DISABILITIES
OH0869298Medicaid