Healthcare Provider Details

I. General information

NPI: 1952435877
Provider Name (Legal Business Name): NOBLE COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46049 MARIETTA ROAD SUITE 4
CALDWELL OH
43724
US

IV. Provider business mailing address

46049 MARIETTA ROAD SUITE 4
CALDWELL OH
43724
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-0407
  • Fax: 740-732-7361
Mailing address:
  • Phone: 740-695-0407
  • Fax: 740-732-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: GLORIA LLEWELLYN
Title or Position: ASSISTANT SUPERINTENDENT
Credential:
Phone: 740-695-0407