Healthcare Provider Details

I. General information

NPI: 1760458889
Provider Name (Legal Business Name): DEVELOPMENTAL RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 SHAGBARK DR
NEVADA IA
50201-2705
US

IV. Provider business mailing address

102 W PARK ST
FOREST CITY IA
50436-2132
US

V. Phone/Fax

Practice location:
  • Phone: 515-382-4549
  • Fax:
Mailing address:
  • Phone: 641-585-5450
  • Fax: 641-585-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number850841
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierIA04211
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerSUBMITTER ID
# 2
Identifier0881292
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. BRENT V ABERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 641-585-5450