Healthcare Provider Details

I. General information

NPI: 1255455010
Provider Name (Legal Business Name): SEVIER COUNTY DEVELOPMENTAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HIGHWAY 399
DE QUEEN AR
71832-0161
US

IV. Provider business mailing address

PO BOX 348
DE QUEEN AR
71832-0348
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-3416
  • Fax: 870-642-8384
Mailing address:
  • Phone: 870-584-3416
  • Fax: 870-642-8384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCERTIFICATE
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberCERTIFICATE
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KERWIN GRAY
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 870-584-3416