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General NPI Number Information
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NPI Number | 1386360022
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Entity Type | Organization
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Legal Business Name | PIKE CO BOARD OF DD
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 330 E. NORTH ST.
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City | WAVERLY
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State | OH
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Zip | 45690
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Country | US
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Telephone | 740-947-8470
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Fax | 740-947-8472
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Provider Business Mailing Address
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Address Line | 330 E. NORTH ST.
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City | WAVERLY
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State | OH
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Zip | 45690
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Country | US
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Telephone | 740-947-8470
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Fax | 740-947-8472
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | JEFF ALLEN
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Credential |
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Telephone | 740-947-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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