NPIMap

Organization Active NPI

Champaign County Board MRDD

  • Developmentally Disabled Services Day Training Agency
  • Urbana, OH
National Provider Identifier
1629191416
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
773140 Issued in OH
Legal business name
CHAMPAIGN COUNTY BOARD MRDD
Practice address
1250 East State Route 36
Urbana, OH 43044
Phone
(937) 653-5217
Fax
(937) 653-7516
NPI assigned
Apr 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Elizabeth Wagner
Title
Business Manager
Phone
(937) 653-5217

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 773140 OH Primary

Addresses

Primary practice location

1250 East State Route 36
Urbana, OH 43044

Mailing address

1250 East State Route 36
P O Box 829
Urbana, OH 43044
Phone (937) 653-5217

Other identifiers 1

IdentifierTypeStateIssuer
773140MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Champaign 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.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629191416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 EAST STATE ROUTE 36",
            "address_2": "P O BOX 829",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "43044",
            "telephone_number": "937-653-5217",
            "fax_number": "937-653-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 EAST STATE ROUTE 36",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "43044",
            "telephone_number": "937-653-5217",
            "fax_number": "937-653-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPAIGN COUNTY BOARD MRDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "937-653-5217"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "OH",
            "license": "773140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "773140",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.