Healthcare Provider Details

I. General information

NPI: 1730219353
Provider Name (Legal Business Name): DERMOTT DAY SERVICE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 NORTH SCHOOL STREET
DERMOTT AR
71638
US

IV. Provider business mailing address

PO BOX 338
DERMOTT AR
71638-0338
US

V. Phone/Fax

Practice location:
  • Phone: 870-538-3043
  • Fax: 870-538-9080
Mailing address:
  • Phone: 870-538-3043
  • Fax: 870-538-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number01270
License Number StateAR

VIII. Authorized Official

Name: MR. JONATHAN HUDSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 870-538-3043