Provider Demographics
NPI:1972734291
Name:DEVELOPMENTAL DISCOVERIES, INC.
Entity type:Organization
Organization Name:DEVELOPMENTAL DISCOVERIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-1466
Mailing Address - Street 1:1219 COMMERCE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2604
Mailing Address - Country:US
Mailing Address - Phone:870-425-1466
Mailing Address - Fax:870-425-1467
Practice Address - Street 1:1219 COMMERCE DR STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2604
Practice Address - Country:US
Practice Address - Phone:870-425-1466
Practice Address - Fax:870-425-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR167255767253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167170715Medicaid
AR167255767Medicaid
AR167163771Medicaid
AR167171775Medicaid
AS167162774Medicaid