Healthcare Provider Details

I. General information

NPI: 1194852749
Provider Name (Legal Business Name): BROWN COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W STATE ST BUILDING A, SUITE 2
GEORGETOWN OH
45121-1229
US

IV. Provider business mailing address

325 WEST STATE STREET BUILDING A, SUITE 2
GEORGETOWN OH
45121-9098
US

V. Phone/Fax

Practice location:
  • Phone: 937-378-4891
  • Fax: 937-378-3585
Mailing address:
  • Phone: 937-378-4891
  • Fax: 937-378-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LENA C. BRADFORD
Title or Position: SUPERINTENDENT
Credential:
Phone: 937-378-4891