Provider Demographics
NPI:1063076594
Name:DEVELOPMENTAL MILESTONES CENTER, LLC
Entity type:Organization
Organization Name:DEVELOPMENTAL MILESTONES CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-733-0560
Mailing Address - Street 1:700 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3150
Mailing Address - Country:US
Mailing Address - Phone:870-733-0560
Mailing Address - Fax:870-733-0561
Practice Address - Street 1:700 N MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3150
Practice Address - Country:US
Practice Address - Phone:870-733-0560
Practice Address - Fax:870-733-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216289732Medicaid