Basic Information
| Provider Information | |||||||||
| NPI: | 1508923061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMBRIDGE DEVELOPMENTAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66737 TOLAND DR | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437251155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404391371 | ||||||||
| FaxNumber: | 7404394382 | ||||||||
| Practice Location | |||||||||
| Address1: | 66737 TOLAND DR | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437251155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404391371 | ||||||||
| FaxNumber: | 7404394382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | BALLINGER | ||||||||
| AuthorizedOfficialFirstName: | CATHLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 7404391371 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | OH | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 2396116 | 05 | OH | MEDICAID |