Licking County Board of MRDD

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

4500016 Issued in OH

Legal business name

LICKING COUNTY BOARD OF MRDD

Practice address

65 W Church St
Newark, OH 43055-5013

Phone

(740) 349-6588

Fax

(740) 349-6595

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gary Smith

Title

Director of Finance

Phone

(740) 349-6588

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Licking County3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Licking County Board of MRDD

  • Case Management Agency
  • Newark, OH
  • NPI 1215795828
  NPD tax ID
• Licking County Health Department

  • Home Health Agency
  • Newark, OH
  • NPI 1255658381
  NPD tax ID

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1295860724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 W CHURCH ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430555013",
            "telephone_number": "740-349-6588",
            "fax_number": "740-349-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 W CHURCH ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430555013",
            "telephone_number": "740-349-6588",
            "fax_number": "740-349-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICKING COUNTY BOARD OF MRDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "740-349-6588",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OH",
            "license": "4500016",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "OH",
            "license": "4500016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0773051",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Licking County
• Licking County Aging Program, Inc.
• Licking County Alcoholism Prevention Program
• Licking County Alcoholism Prevention Program
• Licking County Board of MRDD
• Licking County Community Health Care
• Licking County Educational Service Center
• Licking County Health Department
• Licking Memorial Health Professionals
• Licking Memorial Health System

• Developmentally Disabled Services Day Training Agency in Newark, OH
• Providers in Newark, OH by specialty
• Developmentally Disabled Services Day Training Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.