1053864694 NPI number — HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES

Table of content: (NPI 1053864694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053864694 NPI number — HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HATTIE LARLHAM CENTER FOR CHILDREN WITH DISABLILITES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASSOCIATION FOR THE DEVELOPMENTALLY DISABLED
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053864694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4171 MAIZE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43224-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-274-2272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2016

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0557697 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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