MEDICARE: DEVELOPMENTAL RESOURCES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	990827	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	IA04139	OTHER	IA	SUBMITTER ID

General Provider Information

NPI Number	:	1124094206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL RESOURCES, INC.

Provider Business Mailing Address
First Line	:	102 W PARK ST
Second Line	:
City	:	FOREST CITY
State	:	IA
Zip	:	50436-2132
Country	:	US
Telephone Number	:	641-585-5450
Fax Number	:	641-585-3402

Provider Business Practice Location Address
First Line	:	1000 1ST ST SE
Second Line	:
City	:	CLARION
State	:	IA
Zip	:	50525-2086
Country	:	US
Telephone Number	:	515-532-3843
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. BRENT V ABERG
Credential	:
Telephone Number	:	641-585-5450

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/22/2020

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