MEDICARE: HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053864694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES

Provider Business Mailing Address
First Line	:	9772 DIAGONAL RD
Second Line	:
City	:	MANTUA
State	:	OH
Zip	:	44255-9128
Country	:	US
Telephone Number	:	330-274-2272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 MAIZE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1951
Country	:	US
Telephone Number	:	330-274-2272
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	GREGORY SNYDER
Credential	:
Telephone Number	:	330-840-6851

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	11/17/2020

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