Healthcare Provider Details

I. General information

NPI: 1053435172
Provider Name (Legal Business Name): TRUMBULL COUNTY BOARD OF MRDD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NORTH RD
NILES OH
44446-1918
US

IV. Provider business mailing address

45 NORTH RD
NILES OH
44446-1918
US

V. Phone/Fax

Practice location:
  • Phone: 330-652-9800
  • Fax: 330-652-1345
Mailing address:
  • Phone: 330-652-9800
  • Fax: 330-652-1345

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 Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS A. BURKHARDT
Title or Position: SUPERINTENDENT
Credential: PHD
Phone: 330-652-9800