NPIMap

Organization Active NPI

Youngstown Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Mineral Ridge, OH
National Provider Identifier
1073638458
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
36G589 Issued in OH
Legal business name
YOUNGSTOWN DEVELOPMENTAL CENTER
Practice address
4891 E County Line Rd
Mineral Ridge, OH 44440-9411
Phone
(330) 544-2231
Fax
(330) 544-3519
NPI assigned
Mar 21, 2007
Organization subpart
Yes
Parent organization
STATE OF OHIO DEPT. OF MR/DDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Cynthia M. Renner
Title
Superintendent
Phone
(330) 544-2231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 36G589 OH Primary

Addresses

Primary practice location

4891 E County Line Rd
Mineral Ridge, OH 44440-9411

Mailing address

4891 E County Line Rd
Mineral Ridge, OH 44440-9411
Phone (330) 544-2231

Other identifiers 1

IdentifierTypeStateIssuer
2396134MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031202000209 OH Part B Supplier - Clinic/Group Practice 0143133181 Receives reassigned benefits from 261 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northfield, OH; Youngstown, OH; Toledo, OH; Tiffin, OH; Mt Vernon, OH; Mineral Ridge, OH; Massillon, OH; Huber Heights, OH…

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Central Ohio Pyschiatri41 organizations share this tax ID, including this one
Part of
Central Ohio Pyschiatri

Other organizations with this tax ID 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Locations

4891 E County Line Rd
Mineral Ridge, OH 44440
Phone (330) 544-2231

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1073638458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4891 E COUNTY LINE RD",
            "city": "MINERAL RIDGE",
            "state": "OH",
            "postal_code": "444409411",
            "telephone_number": "330-544-2231",
            "fax_number": "330-544-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4891 E COUNTY LINE RD",
            "city": "MINERAL RIDGE",
            "state": "OH",
            "postal_code": "444409411",
            "telephone_number": "330-544-2231",
            "fax_number": "330-544-3519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUNGSTOWN DEVELOPMENTAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF OHIO DEPT. OF MR/DD",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "RENNER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "330-544-2231",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "36G589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2396134",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineral Ridge, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.