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General NPI Number Information
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NPI Number | 1588795033
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Entity Type | Organization
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Legal Business Name | POLK COUNTY DEVELOPMENTAL CENTER, INC.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 MORROW ST N
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City | MENA
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State | AR
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Zip | 71953-2514
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Country | US
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Telephone | 479-394-2671
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Fax | 479-394-3772
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Provider Business Mailing Address
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Address Line | PO BOX 926
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City | MENA
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State | AR
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Zip | 71953-0926
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Country | US
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Telephone | 479-394-2671
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Fax | 479-394-3772
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARY CURTIS
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Credential |
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Telephone | 479-394-2671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | AR
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