NPIMap

Organization Active NPI

Department of Mental Retardation and Developmental Disabilities

  • Intellectual Disabilities Intermediate Care Facility
  • Columbus, OH
National Provider Identifier
1174670285
Registry record updated Dec 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2514097 Issued in OH
Legal business name
DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Practice address
1601 W Broad St
Columbus, OH 43222-1054
Phone
(614) 272-0509
Fax
(614) 272-1054
NPI assigned
Jan 4, 2007
Last updated
Dec 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2008

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

Authorized official

Name
D Michael Snow
Title
Superintendent
Phone
(614) 272-0509

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 2514097 OH
Intellectual Disabilities Intermediate Care Facility 315P00000X 2514097 OH Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 2514097 OH

Addresses

Primary practice location

1601 W Broad St
Columbus, OH 43222-1054

Mailing address

30 E Broad St
Columbus, OH 43215-3414
Phone (614) 466-1970

Other identifiers 1

IdentifierTypeStateIssuer
2438080MedicaidOH

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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174670285. Details of each certification follow.

  • CCN 36G596 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G596

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COLUMBUS DEVELOPMENTAL CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 3, 2003
Last certification
Nov 26, 2025
Beds
125
Ownership / control type
State
Facility address
1601 West Broad Street
Columbus, OH 43222

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
Appalachian Psych Healt39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

600 N River Rd
Tiffin, OH 44883
Phone (419) 447-1450

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228435200000",
    "number": "1174670285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153414",
            "telephone_number": "614-466-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221054",
            "telephone_number": "614-272-0509",
            "fax_number": "614-272-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-12-05",
        "status": "A",
        "authorized_official_last_name": "SNOW",
        "authorized_official_first_name": "D",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "614-272-0509"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "OH",
            "license": "2514097",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "2514097",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "2514097",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2438080",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.