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General NPI Number Information
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NPI Number | 1124180658
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Entity Type | Organization
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Legal Business Name | SOUTHWEST OHIO DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 4399 E BAUMAN LN
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City | BATAVIA
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State | OH
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Zip | 45103-1685
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Country | US
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Telephone | 513-732-9200
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Fax | 513-735-8232
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Provider Business Mailing Address
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Address Line | 4399 E BAUMAN LN
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City | BATAVIA
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State | OH
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Zip | 45103-1685
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Country | US
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Telephone | 513-732-9200
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Fax | 513-735-8232
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MR. JAMES C. KRUMER
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Credential | MBA
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Telephone | 513-732-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 1310875
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License Number State | OH
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