Tiffin Developmental Center
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Tiffin, OH
NPI 1275686602 · NPPES record last updated Aug 24, 2010
Key facts
- NPI
- 1275686602
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 36G588 (OH)
- Legal business name
- TIFFIN DEVELOPMENTAL CENTER
- Practice address
- 600 N River Rd
Tiffin, OH 44883-1173 - Phone
- (419) 447-1450
- Fax
- (419) 448-6506
- NPI assigned
- Jan 19, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- STATE OF OHIO DEPT. OF DD
Authorized official
- Name
- Mrs. Lois M McQuistion
- Title
- Account Clerk
- Phone
- (419) 447-1450
Other NPIs on the same Medicare enrollment 26
Corporate family (same tax ID) 40
Practitioners 4
-
Rukhsana Alam, MD
-
Bonetta Lou Coulter, APRN-CNS
-
Larry Wayne Johnson, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D1003975 | Tiffin Developmental Center | Certificate of waiver | Sep 16, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- Central Ohio Pyschiatri
- Part of
- Central Ohio Pyschiatri
Locations
1601 W Broad St
Columbus, OH 43222
Phone (614) 272-0509
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 36G588 | OH | Yes |
Addresses
Primary practice location
600 N River Rd
Tiffin, OH 44883-1173
Mailing address
600 N River Rd
Tiffin, OH 44883-1173
Phone (419) 447-1450
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2396107 | Medicaid | OH |
Other providers in Tiffin, OH
- Tiffin Anesthesia Associates
- Tiffin City School District
- Tiffin Convenient Care LLC
- Tiffin Counseling Group
- Tiffin Dental Associates
- Tiffin Emergency Services, LLC
- Tiffin Pediatrics LLC
- Tiffin Psychiatry Center
- Kelsey Christine Tobin
- Mary Burgess Todd
All providers in Tiffin, OH · Intellectual Disabilities Intermediate Care Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.