Organization Active NPI

Clark County

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Springfield, OH
National Provider Identifier
1891969176
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
2082642 Issued in OH
Legal business name
CLARK COUNTY
Practice address
2527 Kenton St
Springfield, OH 45505-3352
Phone
(937) 328-2675
NPI assigned
Apr 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

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

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 2082642 OH Primary

Addresses

Primary practice location

2527 Kenton St
Springfield, OH 45505-3352

Mailing address

2527 Kenton St
Springfield, OH 45505-3352
Phone (937) 328-2675

Other identifiers 1

IdentifierTypeStateIssuer
2082642MedicaidOH

Other names 1

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

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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": "1891969176",
    "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"
        },
        {
            "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"
        }
    ],
    "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": "2082642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2082642",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLARK COUNTY BOARD OF MR/DD - SUNSET ICF/MR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OH

Sources for this page

  • 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.