Provider Demographics
NPI:1780861625
Name:PHILLIPS COUNTY DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:PHILLIPS COUNTY DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:LATARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-572-7447
Mailing Address - Street 1:106 S THIRD
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2901
Mailing Address - Country:US
Mailing Address - Phone:870-572-7447
Mailing Address - Fax:870-572-7654
Practice Address - Street 1:106 S THIRD
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2901
Practice Address - Country:US
Practice Address - Phone:870-572-7447
Practice Address - Fax:870-572-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services