Healthcare Provider Details

I. General information

NPI: 1548159809
Provider Name (Legal Business Name): EASTERSEALS NORTHWEST OHIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E WOOSTER ST STE 28
BOWLING GREEN OH
43402-3466
US

IV. Provider business mailing address

4919 COLDWATER RD
FORT WAYNE IN
46825-5532
US

V. Phone/Fax

Practice location:
  • Phone: 419-386-5693
  • Fax:
Mailing address:
  • Phone: 260-456-4534
  • Fax: 260-745-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA K. ELBRECHT
Title or Position: CEO
Credential:
Phone: 260-969-4241