Provider Demographics
NPI:1952423428
Name:GREENE COUNTY BOARD OF MRDD
Entity Type:Organization
Organization Name:GREENE COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-562-6500
Mailing Address - Street 1:245 N VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9301
Mailing Address - Country:US
Mailing Address - Phone:937-562-6500
Mailing Address - Fax:937-562-6520
Practice Address - Street 1:245 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9301
Practice Address - Country:US
Practice Address - Phone:937-562-6500
Practice Address - Fax:937-562-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH776192251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH776192Medicaid