Provider Demographics
NPI:1275804619
Name:DEVELOPMENTAL CONNECTIONS
Entity Type:Organization
Organization Name:DEVELOPMENTAL CONNECTIONS
Other - Org Name:TANEY COUNTY BOARD FOR THE DEVELOPMENTALLY DISABLED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:LYTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:417-335-4135
Mailing Address - Street 1:1533 E STATE HIGHWAY 76 STE 1
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7422
Mailing Address - Country:US
Mailing Address - Phone:417-335-4135
Mailing Address - Fax:417-334-1316
Practice Address - Street 1:1533 E STATE HIGHWAY 76 STE 1
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7422
Practice Address - Country:US
Practice Address - Phone:417-335-4135
Practice Address - Fax:417-334-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities