Healthcare Provider Details

I. General information

NPI: 1750406211
Provider Name (Legal Business Name): TUSCARAWAS COUNTY BOARD OF DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 COMMERCIAL AVE SW
NEW PHILADELPHIA OH
44663-9365
US

IV. Provider business mailing address

610 COMMERCIAL AVE SW
NEW PHILADELPHIA OH
44663-9365
US

V. Phone/Fax

Practice location:
  • Phone: 330-308-7173
  • Fax: 330-339-7539
Mailing address:
  • Phone: 330-308-7173
  • Fax: 330-339-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NATE KAMBAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 330-339-9779