Provider Demographics
NPI:1144356221
Name:KNOX COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:KNOX COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-397-4656
Mailing Address - Street 1:11700 UPPER GILCHRIST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9295
Mailing Address - Country:US
Mailing Address - Phone:740-397-4656
Mailing Address - Fax:740-392-5669
Practice Address - Street 1:11700 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9295
Practice Address - Country:US
Practice Address - Phone:740-397-4656
Practice Address - Fax:740-392-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567548Medicaid