MEDICARE: OZARK GUIDANCE CENTER, 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		AR

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

General Provider Information

NPI Number	:	1568461887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OZARK GUIDANCE CENTER, INC

Provider Business Mailing Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-751-4346

Provider Business Practice Location Address
First Line	:	2400 S 48TH ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-6683
Country	:	US
Telephone Number	:	479-750-2020
Fax Number	:	479-750-4843

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	PATRICIA YABLONSKI
Credential	:
Telephone Number	:	479-725-5140

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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