MEDICARE: VAN BUREN COUNTY SPECIAL SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1417072208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN BUREN COUNTY SPECIAL SCHOOL

Provider Business Mailing Address
First Line	:	PO BOX 39
Second Line	:
City	:	CHOCTAW
State	:	AR
Zip	:	72028-0039
Country	:	US
Telephone Number	:	501-745-4580
Fax Number	:	501-745-5919

Provider Business Practice Location Address
First Line	:	3707 HWY 95 EAST
Second Line	:
City	:	CHOCTAW
State	:	AR
Zip	:	72028-0039
Country	:	US
Telephone Number	:	501-745-4580
Fax Number	:	501-745-5919

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. NEIL ALLEN WILKINS JR.
Credential	:
Telephone Number	:	501-745-4580

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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