Provider Demographics
NPI:1407151087
Name:ADULT DEVELOPMENT CENTER OF BENTON CO., INC. DBA OPEN AVENUES
Entity Type:Organization
Organization Name:ADULT DEVELOPMENT CENTER OF BENTON CO., INC. DBA OPEN AVENUES
Other - Org Name:OPEN AVENUES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-636-5082
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-0908
Mailing Address - Country:US
Mailing Address - Phone:479-636-5082
Mailing Address - Fax:479-636-5671
Practice Address - Street 1:2202 N 24TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2304
Practice Address - Country:US
Practice Address - Phone:479-636-5082
Practice Address - Fax:479-636-5671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty