MEDICARE: DEVELOPMENTAL DISCOVERIES, 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	253Z00000X	In Home Supportive Care Agency	167255767	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972734291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL DISCOVERIES, INC.

Provider Business Mailing Address
First Line	:	1219 COMMERCE DR STE 3
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2604
Country	:	US
Telephone Number	:	870-425-1466
Fax Number	:	870-425-1467

Provider Business Practice Location Address
First Line	:	1219 COMMERCE DR STE 3
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2604
Country	:	US
Telephone Number	:	870-425-1466
Fax Number	:	870-425-1467

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS TAMMY LYNNE BOSTON
Credential	:
Telephone Number	:	870-425-1466

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/05/2009

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