Provider Demographics
NPI:1396819876
Name:DEVELOPMENTAL CENTER OF THE OZARKS
Entity Type:Organization
Organization Name:DEVELOPMENTAL CENTER OF THE OZARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-829-0893
Mailing Address - Street 1:1545 E PYTHIAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2139
Mailing Address - Country:US
Mailing Address - Phone:417-829-0893
Mailing Address - Fax:417-831-7539
Practice Address - Street 1:1545 E PYTHIAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2139
Practice Address - Country:US
Practice Address - Phone:417-829-0893
Practice Address - Fax:417-831-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation