Organization
HOME COURT ADVANTAGE V
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT MCCRIMMON JR. (ADMINISTRATOR/CEO)
(417) 777-6980
Entity
Organization
Contact information
Practice address
1211 E BROADWAY ST, BOLIVAR, MO 65613-2952
(417) 777-6980
(417) 777-6981
Mailing address
972 E 433RD RD, PO BOX 771, BOLIVAR, MO 65613
(417) 777-6980
(417) 777-6981
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
MO
Other
Enumeration date
11/28/2007
Last updated
11/28/2007
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