Healthcare Provider Details

I. General information

NPI: 1841314135
Provider Name (Legal Business Name): VINTON COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31057 INDUSTRIAL PARK DR
MC ARTHUR OH
45651-9023
US

IV. Provider business mailing address

31835 STATE ROUTE 93
MC ARTHUR OH
45651-9006
US

V. Phone/Fax

Practice location:
  • Phone: 740-596-5515
  • Fax: 740-596-5216
Mailing address:
  • Phone: 740-596-5515
  • Fax: 740-596-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8200011
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: JOHN ROBERT PEKAR
Title or Position: SUPERINTENDENT
Credential:
Phone: 740-652-7220