Healthcare Provider Details

I. General information

NPI: 1982876504
Provider Name (Legal Business Name): HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9772 DIAGONAL ROAD
MANTUA OH
44255
US

IV. Provider business mailing address

9772 DIAGONAL RD
MANTUA OH
44255-9128
US

V. Phone/Fax

Practice location:
  • Phone: 330-274-2272
  • Fax: 330-732-2467
Mailing address:
  • Phone: 330-274-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number0269874
License Number StateOH

VIII. Authorized Official

Name: MR. GREG SNYDER
Title or Position: CFO
Credential:
Phone: 330-840-6851