Healthcare Provider Details

I. General information

NPI: 1780709972
Provider Name (Legal Business Name): COSHOCTON COUNTY BOARD OF MRDD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23720 AIRPORT RD
COSHOCTON OH
43812-9223
US

IV. Provider business mailing address

23720 AIRPORT RD
COSHOCTON OH
43812-9223
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-2032
  • Fax: 740-622-0832
Mailing address:
  • Phone: 740-622-2032
  • Fax: 740-622-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0772990
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0772990
License Number StateOH

VIII. Authorized Official

Name: HEATHER B. KENDALL
Title or Position: SUPERINTENDENT
Credential:
Phone: 740-622-2032