MEDICARE: HAMILTON COUNTY BOARD OF MENTAL RETARDATION AND DEVELOP

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	251C00000X	Developmentally Disabled Services Day Training Agency	310001	OH
2	251B00000X	Case Management Agency	310001	OH

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	:	1770703555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMILTON COUNTY BOARD OF MENTAL RETARDATION AND DEVELOP

Provider Business Mailing Address
First Line	:	1520 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1747
Country	:	US
Telephone Number	:	513-794-3300
Fax Number	:	513-559-6600

Provider Business Practice Location Address
First Line	:	1520 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1747
Country	:	US
Telephone Number	:	513-794-3300
Fax Number	:	513-559-6600

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	LEIA SNYDER
Credential	:
Telephone Number	:	513-794-3300

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	12/21/2022

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