=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134185929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEAUGA COUNTY EDUCATIONAL SERVICE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 CENTER ST BLDG 2
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-279-1706
-----------------------------------------------------
Fax | 440-286-7106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 470 CENTER ST BLDG 2
-----------------------------------------------------
City | CHARDON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-279-1706
-----------------------------------------------------
Fax | 440-286-7106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SPECIAL SERVICES
-----------------------------------------------------
Name | MR. WALTER M WALDBAUER
-----------------------------------------------------
Credential | OCPC II
-----------------------------------------------------
Telephone | 440-279-1706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------