Provider Demographics
NPI:1730219353
Name:DERMOTT DAY SERVICE CENTER, INC.
Entity type:Organization
Organization Name:DERMOTT DAY SERVICE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-538-3043
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638-0338
Mailing Address - Country:US
Mailing Address - Phone:870-538-3043
Mailing Address - Fax:870-538-9080
Practice Address - Street 1:817 NORTH SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:DERMOTT
Practice Address - State:AR
Practice Address - Zip Code:71638
Practice Address - Country:US
Practice Address - Phone:870-538-3043
Practice Address - Fax:870-538-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR01270251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services