Home Court Advantage V

NPI #1144402488 in Bolivar, Missouri

Provider Information

NPI Number: 1144402488
Entity Type: Organization
Organization Name: Home Court Advantage V
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Nov 28, 2007
Last Updated: Nov 28, 2007

Practice Location

Address: 1211 E BROADWAY ST
City: Bolivar
State: Missouri
ZIP Code: 65613-2952
Phone: (417) 777-6980

Authorized Official

Name: MR. ROBERT MCCRIMMON JR.
Title: ADMINISTRATOR/CEO
Phone: (417) 777-6980

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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