NPIMap

Organization Active NPI

Ohio Department of Mental Retardation and Developmental Disabilities

Doing business as Gallipolis Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Gallipolis, OH
National Provider Identifier
1962544635
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
OHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Doing business as
Gallipolis Developmental Center
Practice address
2500 Ohio Ave
Gallipolis, OH 45631-1656
Phone
(740) 446-1642
Fax
(740) 446-1341
NPI assigned
Feb 12, 2007
Last updated
Feb 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Authorized official

Name
Mr. Kevin Davis
Title
Superintendent
Phone
(740) 446-1642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X OH Primary

Addresses

Primary practice location

2500 Ohio Ave
Gallipolis, OH 45631-1656

Mailing address

30 E Broad St
Columbus, OH 43215-3414
Phone (614) 466-1970

Other names 1

  • Gallipolis Developmental Center Doing business as

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…

NPI to CCN mapping 12

The Medicare certification numbers (CCNs) connected to NPI 1962544635. Details of each certification follow.

  • CCN 36G034 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G356 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G357 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G358 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G359 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G361 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G364 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G365 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G366 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G367 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G515 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details
  • CCN 36G587 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G034

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6038
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 17, 1977
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G356

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6039
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 20, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G357

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6040
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G358

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6043
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G359

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6042
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G361

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6041
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 20, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G364

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6045
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 20, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G365

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6046
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 20, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G366

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6047
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 22, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G367

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6044
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 1, 1989
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G515

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEV CTR-BLDG 6050
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 7, 1995
Last certification
Mar 21, 2002
Ownership / control type
STATE
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G587

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GALLIPOLIS DEVELOPMENTAL CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 27, 2003
Last certification
Aug 9, 2023
Beds
96
Ownership / control type
State
Facility address
2500 Ohio Avenue
Gallipolis, OH 45631

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0901045Gallipolis Developmental Center2500 Ohio Avenue, Gallipolis, OH 45631Certificate of waiverMay 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tiffin Developmental Center39 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

30 E Broad St
Rm 1301
Columbus, OH 43215

2500 Ohio Ave
Gallipolis, OH 45631
Phone (740) 446-1642

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": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1962544635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153414",
            "telephone_number": "614-466-1970",
            "fax_number": "614-466-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 OHIO AVE",
            "city": "GALLIPOLIS",
            "state": "OH",
            "postal_code": "456311656",
            "telephone_number": "740-446-1642",
            "fax_number": "740-446-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "740-446-1642",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gallipolis Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gallipolis, OH

Sources for this page

Verify at the official NPI Registry.