NPIMap

Organization Active NPI

Montgomery Developmental Center

  • Mental Illness Intermediate Care Facility
  • Huber Heights, OH
National Provider Identifier
1669538955
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
Legal business name
MONTGOMERY DEVELOPMENTAL CENTER
Practice address
7650 Timbercrest Dr
Huber Heights, OH 45424-2405
Phone
(937) 233-8108
Fax
(937) 233-1477
NPI assigned
Dec 29, 2006
Last updated
Aug 11, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Mr. Doug A Carter
Title
Business Administrator
Phone
(937) 233-8108

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X Primary

Addresses

Primary practice location

7650 Timbercrest Dr
Huber Heights, OH 45424-2405

Mailing address

7650 Timbercrest Dr
Huber Heights, OH 45424-2405
Phone (937) 233-8108

Other identifiers 1

IdentifierTypeStateIssuer
2411278MedicaidOH

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…

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
Central Ohio Pyschiatri39 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

7650 Timbercrest Dr
Huber Heights, OH 45424
Phone (937) 233-8108

Practitioners & affiliated clinicians

Practitioners 1

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1669538955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7650 TIMBERCREST DR",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454242405",
            "telephone_number": "937-233-8108",
            "fax_number": "937-233-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7650 TIMBERCREST DR",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454242405",
            "telephone_number": "937-233-8108",
            "fax_number": "937-233-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY DEVELOPMENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "DOUG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "937-233-8108",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2411278",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huber Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.