Provider Demographics
NPI:1902933781
Name:WOOD COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:WOOD COUNTY BOARD OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY & COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SLUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-352-4700
Mailing Address - Street 1:11160 E GYPSY LANE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9564
Mailing Address - Country:US
Mailing Address - Phone:419-352-5115
Mailing Address - Fax:419-354-4376
Practice Address - Street 1:11160 E GYPSY LANE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9564
Practice Address - Country:US
Practice Address - Phone:419-352-5115
Practice Address - Fax:419-354-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0471832Medicaid
OH0760065Medicaid
OH0471850Medicaid
OH0933646Medicaid
OH0471841Medicaid
OH0760092Medicaid
OH0931095Medicaid
OH0771295Medicaid