Healthcare Provider Details

I. General information

NPI: 1922150200
Provider Name (Legal Business Name): HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 BROOKSEDGE BLVD
WESTERVILLE OH
43081-2821
US

IV. Provider business mailing address

9772 DIAGONAL RD
MANTUA OH
44255-9128
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-4361
  • Fax:
Mailing address:
  • Phone: 614-486-4361
  • Fax: 614-486-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GREGORY SNYDER
Title or Position: CFO
Credential:
Phone: 330-840-6851