Provider Demographics
NPI:1164550190
Name:BENTON COUNTY DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:BENTON COUNTY DEVELOPMENTAL SERVICES, INC.
Other - Org Name:CORNERSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:731-584-2002
Mailing Address - Street 1:198 CANE ST
Mailing Address - Street 2:P.O. BOX 420
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1382
Mailing Address - Country:US
Mailing Address - Phone:731-584-2002
Mailing Address - Fax:731-584-8645
Practice Address - Street 1:198 CANE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1382
Practice Address - Country:US
Practice Address - Phone:731-584-2002
Practice Address - Fax:731-584-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M3-106-6390251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services