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General NPI Number Information
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NPI Number | 1457485104
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Entity Type | Organization
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Legal Business Name | HENRY COUNTY BOARD OF DD
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 135 E MAUMEE AVE
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City | NAPOLEON
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State | OH
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Zip | 43545-2020
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Country | US
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Telephone | 419-599-2892
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Fax | 491-599-5828
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Provider Business Mailing Address
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Address Line | 135 E MAUMEE AVE
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City | NAPOLEON
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State | OH
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Zip | 43545-2020
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Country | US
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Telephone | 419-599-2892
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Fax | 491-599-5828
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MR. STEPHEN TUCKER
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Credential |
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Telephone | 419-599-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 3500018
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 3500018
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License Number State | OH
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