Provider Demographics
NPI:1053435172
Name:TRUMBULL COUNTY BOARD OF MRDD
Entity type:Organization
Organization Name:TRUMBULL COUNTY BOARD OF MRDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-652-9800
Mailing Address - Street 1:45 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-1918
Mailing Address - Country:US
Mailing Address - Phone:330-652-9800
Mailing Address - Fax:330-652-1345
Practice Address - Street 1:45 NORTH RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-1918
Practice Address - Country:US
Practice Address - Phone:330-652-9800
Practice Address - Fax:330-652-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567502Medicaid