CLARK COUNTY BOARD OF MR/DD - BLUE ICF/MR - NPI 1710151097 - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Springfield, OH

Q: What is Clark County's NPI number?

The NPI number for Clark County is 1710151097. It was assigned to this organization in the NPPES registry on April 17, 2008. The provider is doing business as Clark County Board Of Mr/Dd - Blue Icf/Mr.

Q: What is Clark County's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Q: When was this NPI record last updated?

The NPPES record for Clark County was last updated on April 17, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Clark County Board Of Mr/dd - Blue Icf/mr NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLARK COUNTY BOARD OF MR/DD - BLUE ICF/MR (NPI 1710151097) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Springfield, Ohio and active in the NPI registry since April 2008. The organization lists Ravi R Shankar, Comptroller, as its authorized official.

NPPES Registry Identity

NPI1710151097

Entity TypeOrganization

Primary Taxonomy320900000X

Legal Business NameCLARK COUNTY

Location Address2527 KENTON STSpringfield, OH 45505-3352

Mailing Address2527 Kenton StSpringfield, OH 45505-3352 · (937) 328-2675 · Fax (937) 328-4626

Phone(937) 328-2675

Fax(937) 328-4626

Organization SubpartNo

Authorized OfficialRavi R ShankarComptroller · (937) 328-4626

Enumeration DateApril 17, 2008

✔ NPI 1710151097 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

License✔ Licensed in OH · 0559613

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

2527 KENTON ST, Springfield, OH 45505

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Other Names 1

Doing Business AsClark County Board Of Mr/dd - Blue Icf/mr

Other Identifiers 1

Medicaid0559613OH

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLARK COUNTY

Case Management