Basic Information
| Provider Information | |||||||||
| NPI: | 1053031047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OZARK BEHAVIORAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865510 | ||||||||
| FaxNumber: | 5736866846 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865510 | ||||||||
| FaxNumber: | 5736866846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROLLAND | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5736865510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.