Clark County

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

0559613 Issued in OH

Legal business name

CLARK COUNTY

Practice address

2527 Kenton St
Springfield, OH 45505-3352

Phone

(937) 328-2675

Fax

(937) 328-4626

NPI assigned

Apr 17, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Ravi R Shankar

Title

Comptroller

Phone

(937) 328-4626

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CLARK COUNTY BOARD OF MR/DD - BLUE ICF/MR Doing business as

Tax ID family

Clark County10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1083888366
  NPD tax ID
• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1174796684
  NPD tax ID
• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1174797450
  NPD tax ID
• Clark County

  • Public Health or Welfare Agency
  • Springfield, OH
  • NPI 1265549604
  NPD tax ID
• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1801060181
  NPD tax ID
• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1891969176
  NPD tax ID
• Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
  • NPI 1922267053
  NPD tax ID
• Clark County

  • Case Management Agency
  • Springfield, OH
  • NPI 1952592198
  NPD tax ID
• Clark County Sheriff'S Office

  • Public Health or Welfare Agency
  • Springfield, OH
  • NPI 1114024569
  NPD tax ID

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1710151097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2527 KENTON ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455053352",
            "telephone_number": "937-328-2675",
            "fax_number": "937-328-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2527 KENTON ST",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455053352",
            "telephone_number": "937-328-2675",
            "fax_number": "937-328-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-17",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "SHANKAR",
        "authorized_official_first_name": "RAVI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COMPTROLLER",
        "authorized_official_telephone_number": "937-328-4626",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "0559613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0559613",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLARK COUNTY BOARD OF MR/DD - BLUE ICF/MR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelli R Clapper, LSW
• Clark County
• Clark County
• Clark County
• Clark County
• Clark County
• Clark County
• Clark County
• Clark County
• Clark County Dialysis Facility, Inc.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Springfield, OH
• Providers in Springfield, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; 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.