Organization
LAKE OF THE OZARKS DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARILYN LEIGH MARTIN (EXECUTIVE DIRECTOR)
(573) 346-4574
Entity
Organization
Contact information
Practice address
1867 SOUTH STATE HIGHWAY 5, CAMDENTON, MO 65020
(573) 346-4574
(573) 346-7426
Mailing address
PO BOX 753, CAMDENTON, MO 65020-0753
(573) 346-4574
(573) 346-7426
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
15428899
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
15428899
MO
343900000X
Non-emergency Medical Transport (VAN)
15428899
MO
Other
Enumeration date
03/15/2007
Last updated
08/03/2010
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