CLARK COUNTY NPI 1710151097

NPI Information

NPI: 1710151097
Provider Name: CLARK COUNTY

Doing Business As: CLARK COUNTY BOARD OF MR/DD - BLUE ICF/MR

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
2527 KENTON ST
SPRINGFIELD, OH
ZIP 45505
Phone: (937) 328-2675
Get Directions

CLARK COUNTY is a community based residential treatment facility, intellectual and/or developmental disabilities in Springfield, OH. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. CLARK COUNTY NPI is 1710151097. The provider is registered as an organization entity type.
The provider Is Doing Business As Clark County Board Of Mr/dd - Blue Icf/mr.

The provider's business location address is:

2527 KENTON ST
SPRINGFIELD, OH
ZIP 45505-352
Phone: (937) 328-2675
Fax: (937) 328-4626

The provider's authorized official is Ravi R Shankar .
The authorized official title is Comptroller and has the following contact phone number (937) 328-4626.

The enumeration date for this NPI number is 4/17/2008 and was last updated on 4/17/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		0559613	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0559613	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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