Portage County Board of Developmental Disabilit

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

2560072 Issued in OH

Legal business name

PORTAGE COUNTY BOARD OF DEVELOPMENTAL DISABILIT

Practice address

7008 State Route 88
Ravenna, OH 44266-9188

Phone

(330) 296-2839

Fax

(330) 297-8875

NPI assigned

Sep 20, 2005

Organization subpart

Yes

Parent organization

PORTAGE COUNTYAs reported in NPPES

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

Authorized official

Name

Mr. Omar Nagi

Title

Superintendent

Phone

(330) 297-6209

Specialties & licenses 9

Addresses

Other identifiers 1

Tax ID family

Portage County Auditor3 organizations share this tax ID, including this one

Part of

Portage County Auditor

Other organizations with this tax ID 2

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

• Child Health Services of Portage County

  • State or Local Public Health Clinic/Center
  • Ravenna, OH
  • NPI 1942397591
  NPD tax ID
• Portage County Combined General Health District

  • Public Health or Welfare Agency
  • Ravenna, OH
  • NPI 1174671796
  NPD tax ID

Locations

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1639164205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 BRADY LAKE RD",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442661604",
            "telephone_number": "330-297-6209",
            "fax_number": "330-297-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7008 STATE ROUTE 88",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442669188",
            "telephone_number": "330-296-2839",
            "fax_number": "330-297-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE COUNTY BOARD OF DEVELOPMENTAL DISABILIT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PORTAGE COUNTY",
        "enumeration_date": "2005-09-20",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "NAGI",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "330-297-6209",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OH",
            "license": "0776129",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "OH",
            "license": "2560072",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": "2560072",
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "OH",
            "license": "2560072",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OH",
            "license": "2560072",
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "344600000X",
            "taxonomy_group": "",
            "desc": "Taxi",
            "state": "OH",
            "license": "2560072",
            "primary": false
        },
        {
            "code": "347B00000X",
            "taxonomy_group": "",
            "desc": "Bus",
            "state": "OH",
            "license": "2560072",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "OH",
            "license": "2560072",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6700010",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lillian Plumley
• Charlene R. Polasky, MSN, APRN, PMHNP-BC
• Shawna Marie Polverine, CNP
• Portage Choice Homes LLC
• Portage County Auditor (The Woodlands at Robinson)
• Portage County Children's Service Center
• Portage County Children's Services Center (Children's Advantage)
• Portage County Children's Services Center (Children's Advantage)
• Portage County Combined General Health District
• Portage County Educational Service Center

• Developmentally Disabled Services Day Training Agency in Ravenna, OH
• Providers in Ravenna, 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 22, 2016; 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.