Provider Demographics
NPI:1770603359
Name:STARK COUNTY BOARD OF DD
Entity type:Organization
Organization Name:STARK COUNTY BOARD OF DD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-479-3932
Mailing Address - Street 1:2950 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1534
Mailing Address - Country:US
Mailing Address - Phone:330-479-3944
Mailing Address - Fax:330-477-3337
Practice Address - Street 1:2950 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1534
Practice Address - Country:US
Practice Address - Phone:330-477-5200
Practice Address - Fax:330-477-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7600019Medicaid
OHHC1281OtherHOME CHOICE DEMONSTRATION PROGRAM