Provider Demographics
NPI:1952435877
Name:NOBLE COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:NOBLE COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-695-0407
Mailing Address - Street 1:46049 MARIETTA ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724
Mailing Address - Country:US
Mailing Address - Phone:740-695-0407
Mailing Address - Fax:740-732-7361
Practice Address - Street 1:46049 MARIETTA ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724
Practice Address - Country:US
Practice Address - Phone:740-695-0407
Practice Address - Fax:740-732-7361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency