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General NPI Number Information
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NPI Number | 1023600400
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Entity Type | Individual
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Provider Name | RICHARD ALAN BROWN VP OF IDD, COO
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Gender | Male
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 640 MENLO PARK ST SW
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City | HARTVILLE
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State | OH
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Zip | 44632-9698
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Country | US
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Telephone | 330-877-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 880 SUNNYSIDE ST SW
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City | HARTVILLE
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State | OH
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Zip | 44632-9087
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Country | US
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Telephone | 330-877-7700
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Fax | 330-877-7701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 7601796
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License Number State | OH
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