Healthcare Provider Details

I. General information

NPI: 1457485104
Provider Name (Legal Business Name): HENRY COUNTY BOARD OF DD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E MAUMEE AVE
NAPOLEON OH
43545-2020
US

IV. Provider business mailing address

135 E MAUMEE AVE
NAPOLEON OH
43545-2020
US

V. Phone/Fax

Practice location:
  • Phone: 419-599-2892
  • Fax: 491-599-5828
Mailing address:
  • Phone: 419-599-2892
  • Fax: 491-599-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3500018
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3500018
License Number StateOH

VIII. Authorized Official

Name: MR. STEPHEN TUCKER
Title or Position: SUPERINTENDENT
Credential:
Phone: 419-599-2892