Basic Information
| Provider Information | |||||||||
| NPI: | 1811631989 | ||||||||
| 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: | 5733004914 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 N WESTWOOD BLVD STE 14 | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736865510 | ||||||||
| FaxNumber: | 5733004914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2022 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | BARTON | ||||||||
| AuthorizedOfficialFirstName: | CHERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF BUSINESS DEVELOPMENT | ||||||||
| AuthorizedOfficialTelephone: | 5738724219 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.