Department of Mental Retardation and Developmental Disabilities

NPI #1174670285 in Columbus, Ohio

Provider Information

NPI Number: 1174670285
Entity Type: Organization
Organization Name: Department of Mental Retardation and Developmental Disabilities
Primary Specialty: Intermediate Care Facility, Intellectual Disabilities
Enumeration Date: Jan 4, 2007
Last Updated: Dec 5, 2008

Practice Location

Address: 1601 W BROAD ST
City: Columbus
State: Ohio
ZIP Code: 43222-1054
Phone: (614) 272-0509

Authorized Official

Name: D MICHAEL SNOW
Title: SUPERINTENDENT
Phone: (614) 272-0509

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X
Intermediate Care Facility, Mental Illness	310500000X
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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