Provider Demographics
NPI:1639526197
Name:DUVALL CHILD DEVELOPMENT CENTER, LLC
Entity Type:Organization
Organization Name:DUVALL CHILD DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:270-993-2251
Mailing Address - Street 1:10631 HIGHWAY 764
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9735
Mailing Address - Country:US
Mailing Address - Phone:270-993-2251
Mailing Address - Fax:270-233-4141
Practice Address - Street 1:10631 HIGHWAY 764
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9735
Practice Address - Country:US
Practice Address - Phone:270-993-2251
Practice Address - Fax:270-233-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251E00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency