Provider Demographics
NPI:1982604682
Name:DARKE COUNTY BOARD OF DD
Entity Type:Organization
Organization Name:DARKE COUNTY BOARD OF DD
Other - Org Name:WAYNE INDUSTRIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEASECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-459-4601
Mailing Address - Street 1:5844 JAYSVILLE ST JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-9057
Mailing Address - Fax:937-548-8585
Practice Address - Street 1:5844 JAYSVILLE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331
Practice Address - Country:US
Practice Address - Phone:937-548-9057
Practice Address - Fax:937-548-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
OH1900018251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568056Medicaid
OH2556363Medicaid