Healthcare Provider Details

I. General information

NPI: 1821119264
Provider Name (Legal Business Name): GUERNSEY COUNTY BOARD OF DD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60770 SOUTHGATE RD
BYESVILLE OH
43723-9731
US

IV. Provider business mailing address

60770 SOUTHGATE RD
BYESVILLE OH
43723-9731
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-4451
  • Fax: 740-439-7114
Mailing address:
  • Phone: 740-439-4451
  • Fax: 740-439-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLIE R BROWN
Title or Position: SUPERINTENDENT
Credential:
Phone: 740-439-4451