Healthcare Provider Details

I. General information

NPI: 1053439190
Provider Name (Legal Business Name): HOME COURT ADVANTAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E BROADWAY ST
BOLIVAR MO
65613-2952
US

IV. Provider business mailing address

1211 E BROADWAY ST P. O. BOX 771
BOLIVAR MO
65613-2952
US

V. Phone/Fax

Practice location:
  • Phone: 417-777-6980
  • Fax: 417-777-6981
Mailing address:
  • Phone: 417-777-6980
  • Fax: 417-777-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. ROBERT MCCRIMMON
Title or Position: CEO
Credential:
Phone: 417-777-6980