Healthcare Provider Details

I. General information

NPI: 1982604682
Provider Name (Legal Business Name): DARKE COUNTY BOARD OF DD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5844 JAYSVILLE ST JOHNS RD
GREENVILLE OH
45331
US

IV. Provider business mailing address

5844 JAYSVILLE ST JOHNS RD
GREENVILLE OH
45331
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-9057
  • Fax: 937-548-8585
Mailing address:
  • Phone: 937-548-9057
  • Fax: 937-548-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1900018
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL R. BEASECKER
Title or Position: SUPERINTENDENT
Credential:
Phone: 937-459-4601