Healthcare Provider Details

I. General information

NPI: 1427078609
Provider Name (Legal Business Name): DEVELOPMENTAL CENTER OF THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 E PYTHIAN ST
SPRINGFIELD MO
65802-2139
US

IV. Provider business mailing address

1545 E PYTHIAN ST
SPRINGFIELD MO
65802-2139
US

V. Phone/Fax

Practice location:
  • Phone: 417-829-0893
  • Fax: 417-831-7539
Mailing address:
  • Phone: 417-829-0893
  • Fax: 417-831-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLAN MCKELVY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-829-0893