Provider Demographics
NPI:1649057241
Name:IDD ARK, INC.
Entity type:Organization
Organization Name:IDD ARK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-975-3602
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-0597
Mailing Address - Country:US
Mailing Address - Phone:573-975-3602
Mailing Address - Fax:573-375-8467
Practice Address - Street 1:1805 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1037
Practice Address - Country:US
Practice Address - Phone:573-207-2070
Practice Address - Fax:573-375-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child