Healthcare Provider Details

I. General information

NPI: 1770703555
Provider Name (Legal Business Name): HAMILTON COUNTY BOARD OF MENTAL RETARDATION AND DEVELOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 MADISON RD
CINCINNATI OH
45206-1747
US

IV. Provider business mailing address

1520 MADISON RD
CINCINNATI OH
45206-1747
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-3300
  • Fax: 513-559-6600
Mailing address:
  • Phone: 513-794-3300
  • Fax: 513-559-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number310001
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number310001
License Number StateOH

VIII. Authorized Official

Name: LEIA SNYDER
Title or Position: SUPERINTENDENT
Credential:
Phone: 513-794-3300