Provider Demographics
NPI:1659002210
Name:OZARK CENTER
Entity Type:Organization
Organization Name:OZARK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR. CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-347-7670
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7670
Mailing Address - Fax:417-347-0048
Practice Address - Street 1:1949 SNOWBERRY LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5420
Practice Address - Country:US
Practice Address - Phone:417-347-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility