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General NPI Number Information
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NPI Number | 1649057241
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Entity Type | Organization
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Legal Business Name | IDD ARK, INC.
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 1805 W WORLEY ST
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City | COLUMBIA
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State | MO
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Zip | 65203-1037
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Country | US
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Telephone | 573-207-2070
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Fax | 573-375-8467
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Provider Business Mailing Address
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Address Line | PO BOX 597
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City | WENTZVILLE
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State | MO
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Zip | 63385-0597
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Country | US
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Telephone | 573-975-3602
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Fax | 573-375-8467
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BRITTANI GARDNER-EVANS
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Credential |
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Telephone | 573-975-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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