Healthcare Provider Details

I. General information

NPI: 1124184924
Provider Name (Legal Business Name): THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 S US HIGHWAY 68
URBANA OH
43078-9470
US

IV. Provider business mailing address

2380 S US HIGHWAY 68
URBANA OH
43078-9470
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-5291
  • Fax: 937-653-3885
Mailing address:
  • Phone: 937-653-5291
  • Fax: 937-653-3885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA L. CALDWELL
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 937-653-5291