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General NPI Number Information
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NPI Number | 1952423428
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Entity Type | Organization
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Legal Business Name | GREENE COUNTY BOARD OF MRDD
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 245 N VALLEY RD
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City | XENIA
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State | OH
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Zip | 45385-9301
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Country | US
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Telephone | 937-562-6500
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Fax | 937-562-6520
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Provider Business Mailing Address
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Address Line | 245 N VALLEY RD
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City | XENIA
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State | OH
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Zip | 45385-9301
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Country | US
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Telephone | 937-562-6500
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Fax | 937-562-6520
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MR. JOHN C LAROCK
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Credential |
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Telephone | 937-562-6500
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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 | 776192
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License Number State | OH
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