1104892298 NPI number — DEVELOPMENTAL RESOURCES, INC.

Table of content: (NPI 1104892298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104892298 NPI number — DEVELOPMENTAL RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104892298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50436-2132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-585-5450
Provider Business Mailing Address Fax Number:
641-585-3402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50201-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-382-6225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABERG
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
V
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
641-585-5450

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  850442 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IA04210 . This is a "SUBMITTER ID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0881284 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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