Healthcare Provider Details

I. General information

NPI: 1639526197
Provider Name (Legal Business Name): DUVALL CHILD DEVELOPMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 05/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10631 HIGHWAY 764
WHITESVILLE KY
42378-9735
US

IV. Provider business mailing address

10631 HIGHWAY 764
WHITESVILLE KY
42378-9735
US

V. Phone/Fax

Practice location:
  • Phone: 270-993-2251
  • Fax: 270-233-4141
Mailing address:
  • Phone: 270-993-2251
  • Fax: 270-233-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MARY DUVALL
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 270-993-2251